Provider Demographics
NPI:1710213350
Name:SILVER STAR MEDICAL GROUP P A
Entity Type:Organization
Organization Name:SILVER STAR MEDICAL GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-785-5900
Mailing Address - Street 1:6892 SOUTHWEST FWY
Mailing Address - Street 2:STE A-2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2108
Mailing Address - Country:US
Mailing Address - Phone:713-785-5900
Mailing Address - Fax:713-785-5269
Practice Address - Street 1:6892 SOUTHWEST FWY
Practice Address - Street 2:STE A-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2108
Practice Address - Country:US
Practice Address - Phone:713-785-5900
Practice Address - Fax:713-785-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX801181163OtherSECRETARY OF STATE