Provider Demographics
NPI:1790784288
Name:NGUYEN, HUNG THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:HUNG
Middle Name:THANH
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 1:15606 KELLAN CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6115
Mailing Address - Country:US
Mailing Address - Phone:281-351-5235
Mailing Address - Fax:281-351-5235
Practice Address - Street 1:11810 FM 1960 W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3840
Practice Address - Country:US
Practice Address - Phone:832-912-7111
Practice Address - Fax:832-912-7117
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00752VMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
TX8B1554Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TXH94318Medicare UPIN