Provider Demographics
NPI:1316922511
Name:NGUYEN, KHIEM (MD)
Entity type:Individual
Prefix:DR
First Name:KHIEM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1413
Mailing Address - Country:US
Mailing Address - Phone:814-371-0600
Mailing Address - Fax:814-372-4764
Practice Address - Street 1:621 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1413
Practice Address - Country:US
Practice Address - Phone:814-371-0600
Practice Address - Fax:814-372-4764
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068281L207RG0100X
FLME101782207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000347800Medicaid
FLG91809Medicare UPIN
FLBC875ZMedicare PIN
FLBC873Medicare PIN