Provider Demographics
NPI:1962607515
Name:NGUYEN, THUYEN TRUONG (MD)
Entity type:Individual
Prefix:DR
First Name:THUYEN
Middle Name:TRUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:FONDREN 1003
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-1100
Mailing Address - Fax:713-790-6334
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:FONDREN 1003
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-1100
Practice Address - Fax:713-790-6334
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0016939207R00000X
TXM6801207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR018OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX8W4775OtherBLUE CROSS BLUE SHIELD
TX190817005Medicaid
TX190817001Medicaid
TXP00628870OtherMEDICARE RAILROAD
TXP00628870OtherMEDICARE RAILROAD
TX8W4775OtherBLUE CROSS BLUE SHIELD
TXTXB118248Medicare PIN
TXTXB145883Medicare PIN
TX190817005Medicaid