Provider Demographics
NPI:1962581900
Name:NGUYEN PIERCE, KIM THI (PHD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:THI
Last Name:NGUYEN PIERCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3295
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1295
Mailing Address - Country:US
Mailing Address - Phone:310-668-6851
Mailing Address - Fax:310-898-1607
Practice Address - Street 1:921 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3303
Practice Address - Country:US
Practice Address - Phone:310-668-6851
Practice Address - Fax:310-898-1607
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17774103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent