MEDICARE: KIMBERLY NGUYEN DPM PC

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912543109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY NGUYEN DPM PC

Provider Business Mailing Address
First Line	:	1311 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1867
Country	:	US
Telephone Number	:	817-726-1638
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1867
Country	:	US
Telephone Number	:	215-471-0433
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBERLY HOANG NGUYEN
Credential	:	DPM
Telephone Number	:	817-726-1638

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	12/28/2021

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