Healthcare Provider Details

I. General information

NPI: 1962581900
Provider Name (Legal Business Name): KIM THI NGUYEN PIERCE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COMPTON BLVD
COMPTON CA
90221-3303
US

IV. Provider business mailing address

PO BOX 3295
REDONDO BEACH CA
90277-1295
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6851
  • Fax: 310-898-1607
Mailing address:
  • Phone: 310-668-6851
  • Fax: 310-898-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 17774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: