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General NPI Number Information
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NPI Number | 1548352040
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Entity Type | Individual
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Provider Name | KIM PHUONG THI NGUYEN OPTOMETRIST (OD)
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 15333 CULVER DR SUITE 690
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City | IRVINE
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State | CA
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Zip | 92604-3078
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Country | US
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Telephone | 949-552-4271
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Fax |
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Provider Business Mailing Address
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Address Line | 10316 LA CEBRA AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5204
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Country | US
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Telephone | 951-522-7860
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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 | 13066T
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License Number State | CA
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