Provider Demographics
NPI:1841228970
Name:NGUYEN, THIEN BAO (DO)
Entity Type:Individual
Prefix:MR
First Name:THIEN
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2405 S GESSNER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2005
Mailing Address - Country:US
Mailing Address - Phone:713-266-7673
Mailing Address - Fax:713-266-4744
Practice Address - Street 1:2405 S GESSNER RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2005
Practice Address - Country:US
Practice Address - Phone:713-266-7673
Practice Address - Fax:713-266-4744
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124409Medicare PIN
TX8F3328Medicare PIN
TXH83220Medicare UPIN