Provider Demographics
NPI:1679704084
Name:NGUYEN, CHARLES L (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S LOOP W STE 265
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5636
Mailing Address - Country:US
Mailing Address - Phone:713-796-9955
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 265
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5636
Practice Address - Country:US
Practice Address - Phone:713-796-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016027207R00000X
TXQ3746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346176601OtherMEDICAID
TX3462588OtherUNITED HC
TX8FB984OtherBCBS TX
TX240710YKMPOtherMEDICARE
TXP01494090OtherMEDICARE RR
TX6842933OtherCIGNA
TX8FB984OtherBCBS
TX9254841OtherAETNA
TX240710YKMPMedicare PIN