Healthcare Provider Details

I. General information

NPI: 1164272118
Provider Name (Legal Business Name): KHOI NGUYEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HAMPDEN AVE STE 200
ENGLEWOOD CO
80113-2885
US

IV. Provider business mailing address

681 WALDEN CT
HIGHLANDS RANCH CO
80126-3015
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-8844
  • Fax:
Mailing address:
  • Phone: 714-722-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: