Provider Demographics
NPI:1134430267
Name:NGUYEN, KIM-HUONG (DO)
Entity type:Individual
Prefix:
First Name:KIM-HUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S CHESTER PIKE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1830
Mailing Address - Country:US
Mailing Address - Phone:610-586-2122
Mailing Address - Fax:610-586-0612
Practice Address - Street 1:39 S CHESTER PIKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1830
Practice Address - Country:US
Practice Address - Phone:610-586-2122
Practice Address - Fax:610-586-0612
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA207Q00000XMedicaid