Provider Demographics
NPI:1962649491
Name:NIKKO, ANTHONY PHAN (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PHAN
Last Name:NIKKO
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 1:4707 EIGEL ST.
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3417
Mailing Address - Country:US
Mailing Address - Phone:713-960-1311
Mailing Address - Fax:713-960-1325
Practice Address - Street 1:4707 EIGEL ST.
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3417
Practice Address - Country:US
Practice Address - Phone:713-960-1311
Practice Address - Fax:713-960-1325
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5639207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology