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NPI Code Detail

MEDICARE: DR. KIM-THY HOANG NGUYEN DO

MEDICARE: DR. KIM-THY HOANG NGUYEN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician22086CA

General Provider Information

NPI Number : 1053040709
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIM-THY HOANG NGUYEN DO
Provider Business Mailing Address
First Line : 100 CORPORATE POINTE STE 270
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-8735
Country : US
Telephone Number : 424-266-7472
Fax Number : 310-596-8268
Provider Business Practice Location Address
First Line : 5901 GREEN VALLEY CIR STE 405
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-6971
Country : US
Telephone Number : 424-266-7474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2022
Last Update Date : 10/14/2025

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