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General NPI Number Information
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NPI Number | 1093045833
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Entity Type | Individual
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Provider Name | KIM PHUONG LUCY NGUYEN-CASEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 504 W PUEBLO ST SUITE 202
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City | SANTA BARBARA
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State | CA
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Zip | 93105-6211
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Country | US
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Telephone | 805-682-6455
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Fax | 805-687-1482
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Provider Business Mailing Address
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Address Line | 2921 DE LA VINA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93105-3309
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Country | US
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Telephone | 408-603-3156
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21330
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License Number State | CA
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