Provider Demographics
NPI:1083862304
Name:NGUYEN, KIM DOAN (LAC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:DOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 WEST BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3107
Mailing Address - Country:US
Mailing Address - Phone:703-237-1114
Mailing Address - Fax:703-237-7644
Practice Address - Street 1:821 WEST BROAD ST.
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3107
Practice Address - Country:US
Practice Address - Phone:703-237-1114
Practice Address - Fax:703-237-7644
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000515171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist