Healthcare Provider Details

I. General information

NPI: 1265913255
Provider Name (Legal Business Name): KIDZ CARDIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 E SHANNON WOODS ST STE 108
WICHITA KS
67226-4104
US

IV. Provider business mailing address

10100 E SHANNON WOODS ST STE 108
WICHITA KS
67226-4104
US

V. Phone/Fax

Practice location:
  • Phone: 316-282-3443
  • Fax:
Mailing address:
  • Phone: 316-282-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TUAN NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 316-680-4145