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General NPI Number Information
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NPI Number | 1003536749
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Entity Type | Individual
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Provider Name | KIM NGUYEN OD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 5572 AVERY DR
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City | MARRERO
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State | LA
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Zip | 70072-5138
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Country | US
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Telephone | 504-214-1627
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 MEDICAL CENTER BLVD
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City | MARRERO
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State | LA
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Zip | 70072-3151
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Country | US
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Telephone | 504-347-6330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-F05-TA-C64
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 009630
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2012-958AT
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License Number State | LA
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