Provider Demographics
NPI:1831629443
Name:NGUYEN, THU MINH NGOC (DO)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:MINH NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E US HWY 290
Mailing Address - Street 2:STE. 240 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1144
Mailing Address - Country:US
Mailing Address - Phone:512-338-3826
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:22420 IH 35 STE 203
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2656
Practice Address - Country:US
Practice Address - Phone:512-272-4636
Practice Address - Fax:512-406-7327
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6003208000000X
IL125070866390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX414932001Medicaid
TX414932002Medicaid