Provider Demographics
NPI:1942261771
Name:NGUYEN, TRUNG D (MD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:D
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 1:900 W MAGNOLIA AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8517
Mailing Address - Country:US
Mailing Address - Phone:817-921-5997
Mailing Address - Fax:817-921-5998
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:STE. 201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-921-5997
Practice Address - Fax:817-921-5998
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030487501Medicaid
TXG68766Medicare UPIN
TX8F2429Medicare PIN