Healthcare Provider Details

I. General information

NPI: 1407692163
Provider Name (Legal Business Name): KEVIN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9231 W OLYMPIC BLVD
BEVERLY HILLS CA
90212-4658
US

IV. Provider business mailing address

9231 W OLYMPIC BLVD
BEVERLY HILLS CA
90212-4658
US

V. Phone/Fax

Practice location:
  • Phone: 714-725-1626
  • Fax:
Mailing address:
  • Phone: 714-725-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number67904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: