Provider Demographics
NPI:1528165438
Name:HOUSTON HEAD AND NECK SURGICAL PA
Entity type:Organization
Organization Name:HOUSTON HEAD AND NECK SURGICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHOA
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-897-1112
Mailing Address - Street 1:10311 N ELDRIDGE PKWY
Mailing Address - Street 2:#B4
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5368
Mailing Address - Country:US
Mailing Address - Phone:281-897-1112
Mailing Address - Fax:281-897-9993
Practice Address - Street 1:10311 N ELDRIDGE PKWY
Practice Address - Street 2:#B4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5368
Practice Address - Country:US
Practice Address - Phone:281-897-1112
Practice Address - Fax:281-897-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8981207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI10606Medicare UPIN