Provider Demographics
NPI:1174595219
Name:NGUYEN, TRUONG CHINH QUOC (MD)
Entity type:Individual
Prefix:
First Name:TRUONG CHINH
Middle Name:QUOC
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 1:1716 MCDUFFIE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-5727
Mailing Address - Country:US
Mailing Address - Phone:713-494-2020
Mailing Address - Fax:
Practice Address - Street 1:2060 SPACE PARK DR STE 308
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3675
Practice Address - Country:US
Practice Address - Phone:281-333-2744
Practice Address - Fax:281-335-4529
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5489207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164498106Medicaid
TX8J0481OtherMEDICARE ID, UTMB 2012
TX8F9693Medicare PIN
TX164498106Medicaid
TX8E0313Medicare ID - Type UnspecifiedEAST AUSTIN
TXH99667Medicare UPIN