Provider Demographics
NPI:1528448024
Name:NGUYEN, SAN FRANCISCO KIM (DO)
Entity type:Individual
Prefix:DR
First Name:SAN FRANCISCO
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 LEILEHUA RD BLDGS 680
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786
Mailing Address - Country:US
Mailing Address - Phone:808-656-1628
Mailing Address - Fax:
Practice Address - Street 1:681 LEILEHUA RD BLDGS 680
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-9678
Practice Address - Country:US
Practice Address - Phone:808-656-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-2053207P00000X
GA00009098207P00000X
WAOP61389308207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2250908Medicaid