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NPI Code Detail

MEDICARE: JIMMY KHANG NGUYEN PA-C

MEDICARE: JIMMY KHANG NGUYEN PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1730049552
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY KHANG NGUYEN PA-C
Provider Business Mailing Address
First Line : 3059 VOYAGER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8303
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3059 VOYAGER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8303
Country : US
Telephone Number : 920-965-0345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2025
Last Update Date : 11/14/2025

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