Provider Demographics
NPI:1982659629
Name:NGUYEN, TAI NHAN
Entity Type:Individual
Prefix:DR
First Name:TAI
Middle Name:NHAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 ASTORIA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6043
Mailing Address - Country:US
Mailing Address - Phone:281-481-8878
Mailing Address - Fax:281-481-9020
Practice Address - Street 1:11920 ASTORIA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6043
Practice Address - Country:US
Practice Address - Phone:281-481-8878
Practice Address - Fax:281-481-9020
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80X003Medicare PIN
TXG45356Medicare UPIN