Provider Demographics
NPI:1487401659
Name:NGUYEN, KIM KHUYEN THI (NP)
Entity type:Individual
Prefix:
First Name:KIM KHUYEN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 GARDEN VIEW CT STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2481
Mailing Address - Country:US
Mailing Address - Phone:760-783-0441
Mailing Address - Fax:
Practice Address - Street 1:781 GARDEN VIEW CT STE 100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2481
Practice Address - Country:US
Practice Address - Phone:760-783-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-04
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95134489163WG0000X
CA95030297363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice