MEDICARE: DR. KIM T NGUYEN O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12339T	CA

General Provider Information

NPI Number	:	1265463806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM T NGUYEN O.D

Provider Business Mailing Address
First Line	:	8347 ELK GROVE FLORIN RD
Second Line	:	SUITE 123
City	:	SACRAMENTO
State	:	CA
Zip	:	95829
Country	:	US
Telephone Number	:	916-681-1101
Fax Number	:	916-682-8891

Provider Business Practice Location Address
First Line	:	8347 ELK GROVE FLORIN RD
Second Line	:	SUITE123
City	:	SACRAMENTO
State	:	CA
Zip	:	95829
Country	:	US
Telephone Number	:	916-681-1101
Fax Number	:	916-682-8891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/11/2022

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