Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | H5194 | TX |
NPI | 1023015203 |
---|---|
Provider Name | Van Van Nguyen |
First Address | Houston, TX 77090-2213 |
Second Address | Houston, TX 77090-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 22/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1211641-01 | (05) | TX |
808204 | BLUE CROSS BLUE SHIELD (01) | TX |
E11079 | (02) |