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General NPI Number Information
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NPI Number | 1265590897
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Entity Type | Individual
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Provider Name | KHANG THAI NGUYEN MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 2775 VIA DE LA VALLE 101
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City | DEL MAR
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State | CA
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Zip | 92014-1921
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Country | US
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Telephone | 858-869-7729
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Fax | 888-347-0124
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Provider Business Mailing Address
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Address Line | 2775 VIA DE LA VALLE 101
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City | DEL MAR
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State | CA
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Zip | 92014-1921
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Country | US
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Telephone | 858-869-7729
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Fax | 888-347-0124
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A90876
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License Number State | CA
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