Healthcare Provider Details

I. General information

NPI: 1588920268
Provider Name (Legal Business Name): KIM T NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 GATEWAY PL
SAN JOSE CA
95110-3709
US

IV. Provider business mailing address

1339 KANSAS ST
SAN FRANCISCO CA
94107-3242
US

V. Phone/Fax

Practice location:
  • Phone: 657-500-0634
  • Fax:
Mailing address:
  • Phone: 415-418-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number128291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: