Provider Demographics
NPI:1942442108
Name:PHONG NGUYEN-HO, M.D., P.A.
Entity Type:Organization
Organization Name:PHONG NGUYEN-HO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN-HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-202-8858
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:716-202-8858
Mailing Address - Fax:716-989-4536
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:STE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:716-202-8858
Practice Address - Fax:716-989-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4007Medicare PIN