Healthcare Provider Details

I. General information

NPI: 1265590897
Provider Name (Legal Business Name): KHANG THAI NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KARL THAI NGUYEN MD

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 VIA DE LA VALLE 101
DEL MAR CA
92014-1921
US

IV. Provider business mailing address

2775 VIA DE LA VALLE 101
DEL MAR CA
92014-1921
US

V. Phone/Fax

Practice location:
  • Phone: 858-869-7729
  • Fax: 888-347-0124
Mailing address:
  • Phone: 858-869-7729
  • Fax: 888-347-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA90876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: