Provider Demographics
NPI:1033681721
Name:NGUYEN, KEVIN GIA
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:GIA
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 LEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4000
Mailing Address - Country:US
Mailing Address - Phone:866-227-1211
Mailing Address - Fax:
Practice Address - Street 1:445 LEIGH AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4000
Practice Address - Country:US
Practice Address - Phone:866-227-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF3016570OtherDMV