Provider Demographics
NPI:1285969162
Name:NGUYENDO, LONG THANH (MD)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:THANH
Last Name:NGUYENDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:MCHE-MDM
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-5000
Mailing Address - Fax:210-916-2777
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:MCHE-MDM
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-5000
Practice Address - Fax:210-916-2777
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA65981207R00000X
CAC162879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine