Provider Demographics
NPI:1972916617
Name:NGUYEN, KIMBERLY (DPM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 CRUMS MILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2898
Mailing Address - Country:US
Mailing Address - Phone:717-657-5050
Mailing Address - Fax:717-657-9350
Practice Address - Street 1:4230 CRUMS MILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2898
Practice Address - Country:US
Practice Address - Phone:717-657-5050
Practice Address - Fax:717-657-9350
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003856213E00000X
390200000X
PASC006895213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program