Provider Demographics
NPI:1588778922
Name:NGUYEN, THANH-NHAN T (MD)
Entity type:Individual
Prefix:
First Name:THANH-NHAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3192
Mailing Address - Country:US
Mailing Address - Phone:214-857-1911
Mailing Address - Fax:241-857-2023
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:SUITE 11C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1911
Practice Address - Fax:214-857-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF91446Medicare UPIN