MEDICARE: DR KIM ANH NGUYEN LLC

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	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	DO2258	OTHER	NV	MEDICAL LICENSE

General Provider Information

NPI Number	:	1871164855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KIM ANH NGUYEN LLC

Provider Business Mailing Address
First Line	:	5920 S RAINBOW BLVD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4209
Country	:	US
Telephone Number	:	702-763-2002
Fax Number	:	877-414-2638

Provider Business Practice Location Address
First Line	:	5920 S RAINBOW BLVD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4209
Country	:	US
Telephone Number	:	702-763-2002
Fax Number	:	877-414-2638

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	KIM ANH NGUYEN
Credential	:	DO
Telephone Number	:	702-763-2002

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	03/28/2023

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Directions to “DR KIM ANH NGUYEN LLC ” Practice Location

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