Provider Demographics
NPI:1528620390
Name:NGUYEN, KIM-LOAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM-LOAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LOAN
Other - Middle Name:KIM
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2200 E 4500 S STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4032
Mailing Address - Country:US
Mailing Address - Phone:801-288-1888
Mailing Address - Fax:
Practice Address - Street 1:2200 E 4500 S STE 100
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4032
Practice Address - Country:US
Practice Address - Phone:801-288-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5005527-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice