Provider Demographics
NPI:1215091434
Name:TIEP KIM NGUYEN MD INC
Entity type:Organization
Organization Name:TIEP KIM NGUYEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIEP
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-764-5775
Mailing Address - Street 1:12650 SHERMAN WAY
Mailing Address - Street 2:SUITE3
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605
Mailing Address - Country:US
Mailing Address - Phone:818-764-5775
Mailing Address - Fax:818-764-6273
Practice Address - Street 1:12650 SHERMAN WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5232
Practice Address - Country:US
Practice Address - Phone:818-764-5775
Practice Address - Fax:818-764-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center