MEDICARE: DR. KIM-KHANH NGUYEN O.D.

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	152W00000X	Optometrist	14282	CA

General Provider Information

NPI Number	:	1649550013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM-KHANH NGUYEN O.D.

Provider Business Mailing Address
First Line	:	451 BLOSSOM HILL RD STE 10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1658
Country	:	US
Telephone Number	:	408-281-3926
Fax Number	:	408-281-2515

Provider Business Practice Location Address
First Line	:	451 BLOSSOM HILL RD STE 10
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1658
Country	:	US
Telephone Number	:	408-281-3926
Fax Number	:	408-281-2515

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	01/26/2022

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