Provider Demographics
NPI:1750814232
Name:NHONTHACHIT, PHETSAMONG (MD)
Entity Type:Individual
Prefix:
First Name:PHETSAMONG
Middle Name:
Last Name:NHONTHACHIT
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 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:4755 ALDINE MAIL ROUTE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-5934
Practice Address - Country:US
Practice Address - Phone:281-985-7600
Practice Address - Fax:281-985-7620
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47182207Q00000X
TXS8351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine