Provider Demographics
NPI:1487639886
Name:NGUYEN, DZUNG AN (MD)
Entity type:Individual
Prefix:MR
First Name:DZUNG
Middle Name:AN
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:PO BOX 720705
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77272-0705
Mailing Address - Country:US
Mailing Address - Phone:713-520-1115
Mailing Address - Fax:281-271-8414
Practice Address - Street 1:7601 W SAM HOUSTON PARKWAY SOUTH
Practice Address - Street 2:SUITE 850
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072
Practice Address - Country:US
Practice Address - Phone:713-520-1115
Practice Address - Fax:281-271-8414
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4324208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014900OtherAMERIGROUP
TX112058602Medicaid
TX112058601Medicaid
TX112058602Medicaid
TX10014900OtherAMERIGROUP