Provider Demographics
NPI:1760126528
Name:NGUYEN, NAM HOAI (PA-C)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:HOAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:NAM
Other - Middle Name:HOAI
Other - Last Name:TRAN NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1704 YORKTOWN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2535
Mailing Address - Country:US
Mailing Address - Phone:817-903-1377
Mailing Address - Fax:
Practice Address - Street 1:6320 U.S. 287 FRONTAGE RD
Practice Address - Street 2:STE. #112
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-778-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant