Provider Demographics
NPI:1477632586
Name:NGUYEN, LAN KELLY (MD)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:KELLY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4830 WILSON ROAD
Mailing Address - Street 2:SUITE 300 PMB 205
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1972
Mailing Address - Country:US
Mailing Address - Phone:282-636-6101
Mailing Address - Fax:281-667-0910
Practice Address - Street 1:1101 ALMA ST STE 106
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4559
Practice Address - Country:US
Practice Address - Phone:281-636-6101
Practice Address - Fax:281-667-0910
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM5406208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186743403Medicaid
TX186743402Medicaid
8L5291Medicare PIN
TX8F8239Medicare PIN
TX8BE052OtherBCBS