Provider Demographics
NPI:1053040709
Name:NGUYEN, KIM-THY HOANG (DO)
Entity type:Individual
Prefix:DR
First Name:KIM-THY
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 CORPORATE POINTE STE 270
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8735
Mailing Address - Country:US
Mailing Address - Phone:424-266-7472
Mailing Address - Fax:310-596-8268
Practice Address - Street 1:5901 GREEN VALLEY CIR STE 405
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6971
Practice Address - Country:US
Practice Address - Phone:424-266-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine