Provider Demographics
NPI:1972782829
Name:NGUYEN, KY NGOC (MD)
Entity type:Individual
Prefix:MR
First Name:KY
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9141 BOLSA AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1302
Mailing Address - Country:US
Mailing Address - Phone:714-898-1526
Mailing Address - Fax:714-373-5244
Practice Address - Street 1:9141 BOLSA AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-1302
Practice Address - Country:US
Practice Address - Phone:714-898-1526
Practice Address - Fax:714-373-5244
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA32504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA32504AOtherRENDERING PROVIDER NUMBER