Basic Information
| Provider Information | |||||||||
| NPI: | 1265033930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | PHUONG | ||||||||
| MiddleName: | DINH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9717 JONES RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770654303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135686095 | ||||||||
| FaxNumber: | 7139654091 | ||||||||
| Practice Location | |||||||||
| Address1: | 9717 JONES RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770654303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135686095 | ||||||||
| FaxNumber: | 7139654091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2020 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | F01210800 | TX | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 163WG0000X | 849550 | TX | N | Nursing Service Providers | Registered Nurse | General Practice | 208VP0000X | 1029237 | TX | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.