Provider Demographics
NPI:1952345506
Name:NGUYEN, PHONG HOAI (MD)
Entity type:Individual
Prefix:DR
First Name:PHONG
Middle Name:HOAI
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 1:2430 NORTH FRY ROAD
Mailing Address - Street 2:#100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084
Mailing Address - Country:US
Mailing Address - Phone:281-829-3999
Mailing Address - Fax:281-829-5146
Practice Address - Street 1:2430 NORTH FRY ROAD
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084
Practice Address - Country:US
Practice Address - Phone:281-829-3999
Practice Address - Fax:281-829-5146
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038316801Medicaid
TX8105J1OtherBCBSTX
TX038316803Medicaid
TX930091554OtherRAILROAD MEDICARE
TX038316803Medicaid
TX930091554OtherRAILROAD MEDICARE
TX00260FMedicare ID - Type Unspecified
TX038316801Medicaid