Provider Demographics
NPI:1265033930
Name:NGUYEN, PHUONG DINH (NP)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:DINH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 JONES RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4303
Mailing Address - Country:US
Mailing Address - Phone:713-568-6095
Mailing Address - Fax:713-965-4091
Practice Address - Street 1:9717 JONES RD STE 107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4303
Practice Address - Country:US
Practice Address - Phone:713-568-6095
Practice Address - Fax:713-965-4091
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF01210800208VP0000X
TX849550163WG0000X
TX1029237208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty