MEDICARE: DR. THIEN HUONG KIM 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	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	9919TG	TX

General Provider Information

NPI Number	:	1699058032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THIEN HUONG KIM NGUYEN O.D.

Provider Business Mailing Address
First Line	:	126 SAGE WAY
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28147-6551
Country	:	US
Telephone Number	:	206-384-0401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2547 E COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203-1907
Country	:	US
Telephone Number	:	210-930-8687
Fax Number	:

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/09/2020

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