Healthcare Provider Details

I. General information

NPI: 1184560146
Provider Name (Legal Business Name): KAYLEE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22433 N SUMMIT RIDGE CIR
CHATSWORTH CA
91311-2691
US

IV. Provider business mailing address

22433 N SUMMIT RIDGE CIR
CHATSWORTH CA
91311-2691
US

V. Phone/Fax

Practice location:
  • Phone: 818-599-9053
  • Fax:
Mailing address:
  • Phone: 818-599-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: