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General NPI Number Information
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NPI Number | 1801556188
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Entity Type | Individual
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Provider Name | KIMOANH THI NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 12865 MAIN ST STE 105
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City | GARDEN GROVE
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State | CA
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Zip | 92840-8205
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Country | US
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Telephone | 800-768-1977
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Fax | 800-768-1977
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Provider Business Mailing Address
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Address Line | 8052 CAMBRIA CIR
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City | STANTON
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State | CA
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Zip | 90680-8503
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Country | US
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Telephone | 714-270-5284
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95018074
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License Number State | CA
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