Provider Demographics
NPI:1114040540
Name:NGUYEN, KARI V (OD)
Entity type:Individual
Prefix:DR
First Name:KARI
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S WEYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4627
Mailing Address - Country:US
Mailing Address - Phone:714-283-2752
Mailing Address - Fax:
Practice Address - Street 1:1081 N TUSTIN AVE STE 113
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1737
Practice Address - Country:US
Practice Address - Phone:714-632-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 9738T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0783426Medicaid
CA0783426Medicaid