Provider Demographics
NPI:1548352040
Name:NGUYEN, KIM PHUONG THI (OPTOMETRIST (OD))
Entity type:Individual
Prefix:DR
First Name:KIM PHUONG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OPTOMETRIST (OD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 LA CEBRA AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5204
Mailing Address - Country:US
Mailing Address - Phone:951-522-7860
Mailing Address - Fax:
Practice Address - Street 1:15333 CULVER DR
Practice Address - Street 2:SUITE 690
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3078
Practice Address - Country:US
Practice Address - Phone:949-552-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13066T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist