Provider Demographics
NPI:1154953560
Name:HULTS NGUYEN, KIM N (PA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:N
Last Name:HULTS NGUYEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TRAVELER ST APT 204
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2980
Mailing Address - Country:US
Mailing Address - Phone:857-294-2023
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS ST STE 201
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-789-2442
Practice Address - Fax:617-202-4349
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7424363AS0400X
363AS0400X
MAPA7424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical