MEDICARE: DR. KIMLOAN PHI NGUYEN MD

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
1	207Q00000X	Family Medicine Physician	27397	OK
2	207Q00000X	Family Medicine Physician	N7851	TX

General Provider Information

NPI Number	:	1497955934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMLOAN PHI NGUYEN MD

Provider Business Mailing Address
First Line	:	2999 OLYMPUS BLVD APT 300
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-1205
Country	:	US
Telephone Number	:	214-645-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2999 OLYMPUS BLVD APT 300
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-1205
Country	:	US
Telephone Number	:	214-645-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	08/09/2023

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