Provider Demographics
NPI:1891959748
Name:NGUYEN, DUY NGOC (DO)
Entity Type:Individual
Prefix:DR
First Name:DUY
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W IRVING BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6878
Mailing Address - Country:US
Mailing Address - Phone:972-254-0911
Mailing Address - Fax:
Practice Address - Street 1:1900 W IRVING BLVD STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6878
Practice Address - Country:US
Practice Address - Phone:972-254-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8285261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care