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General NPI Number Information
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NPI Number | 1790133007
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Entity Type | Individual
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Provider Name | KIM THAO THI NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 25 N 14TH ST SUITE 550
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City | SAN JOSE
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State | CA
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Zip | 95112
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Country | US
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Telephone | 408-294-3922
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Fax | 408-294-4657
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Provider Business Mailing Address
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Address Line | 25 N 14TH ST SUITE 550
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City | SAN JOSE
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State | CA
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Zip | 95112
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Country | US
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Telephone | 408-294-3922
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Fax | 408-294-4657
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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