=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699058032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THIEN HUONG KIM NGUYEN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2011
-----------------------------------------------------
Last Update Date | 09/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2547 E COMMERCE ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78203-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-930-8687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 SAGE WAY
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28147-6551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-384-0401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 9919TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------