Provider Demographics
NPI:1689896904
Name:NGUYEN, HIEU
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 BELLAIRE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2569
Mailing Address - Country:US
Mailing Address - Phone:281-530-9947
Mailing Address - Fax:
Practice Address - Street 1:12060 BELLAIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2569
Practice Address - Country:US
Practice Address - Phone:281-530-9947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20854174400000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00300Medicare UPIN
610560Medicare ID - Type Unspecified