Provider Demographics
NPI:1194792309
Name:NGUYEN, CHI KIM (MD)
Entity type:Individual
Prefix:DR
First Name:CHI
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:5149 N NINTH AVENUE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8779
Practice Address - Country:US
Practice Address - Phone:850-416-6894
Practice Address - Fax:850-416-2487
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83973207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933585Medicaid
FL266958700Medicaid
AL009933585Medicaid
FL266958700Medicaid
FL29259XMedicare PIN