Provider Demographics
NPI:1053384321
Name:NGUYEN, KEVIN THONG (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THONG
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 1:5310 GALAXIE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-4502
Mailing Address - Country:US
Mailing Address - Phone:214-221-6362
Mailing Address - Fax:214-345-8784
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4426
Practice Address - Country:US
Practice Address - Phone:214-221-6362
Practice Address - Fax:214-345-8784
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502187Medicaid
TX210477001Medicaid
TX210477002Medicaid
TX210477002Medicaid
TX210477001Medicaid
TX8L25502Medicare PIN
NV100502187Medicaid