Provider Demographics
NPI:1053659508
Name:NGUYEN DMD PA
Entity Type:Organization
Organization Name:NGUYEN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-612-7777
Mailing Address - Street 1:9415 E HARRY ST STE 606
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5082
Mailing Address - Country:US
Mailing Address - Phone:316-612-7777
Mailing Address - Fax:
Practice Address - Street 1:9415 E HARRY ST STE 606
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5082
Practice Address - Country:US
Practice Address - Phone:316-612-7777
Practice Address - Fax:316-612-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty