Provider Demographics
NPI:1710903257
Name:NGUYEN, KY Q (MD)
Entity Type:Individual
Prefix:
First Name:KY
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:10401 ANDERSON MILL RD STE 110B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2579
Practice Address - Country:US
Practice Address - Phone:512-250-5571
Practice Address - Fax:512-406-7300
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10915R208000000X
TXM8212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196285401Medicaid
LA199517Medicaid
TX196285403Medicaid
TX196285402Medicaid
TX196285404Medicaid
5U708Medicare ID - Type Unspecified
LA199517Medicaid
TX196285404Medicaid
TX8K9542Medicare PIN
TXTXB118301Medicare PIN
TXTXB118303Medicare PIN