Provider Demographics
NPI:1215959556
Name:NGUYEN-KHOA, KEVIN (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:NGUYEN-KHOA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 E PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5868
Mailing Address - Country:US
Mailing Address - Phone:817-265-1595
Mailing Address - Fax:817-200-7991
Practice Address - Street 1:1327 E PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5868
Practice Address - Country:US
Practice Address - Phone:817-265-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP 1396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00286EMedicare ID - Type Unspecified
TXU71950Medicare UPIN