Basic Information
Provider Information
NPI: 1003805813
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: DOMINIQUE
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 840853
Address2:  
City: DALLAS
State: TX
PostalCode: 752840853
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1500 CITYWEST BLVD STE 300
Address2:  
City: HOUSTON
State: TX
PostalCode: 77042
CountryCode: US
TelephoneNumber: 7136204000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 04/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XK3356TXY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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