Provider Demographics
NPI:1285752113
Name:NGUYEN, KIM XUAN THI (DC)
Entity type:Individual
Prefix:
First Name:KIM XUAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0995
Practice Address - Street 1:2120 S WAYSIDE DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3900
Practice Address - Country:US
Practice Address - Phone:713-803-1840
Practice Address - Fax:713-926-5852
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU8617Medicare UPIN