Provider Demographics
NPI:1073785960
Name:NGUYEN KY DPM, INC
Entity Type:Organization
Organization Name:NGUYEN KY DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-292-2485
Mailing Address - Street 1:660 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1931
Mailing Address - Country:US
Mailing Address - Phone:408-292-2485
Mailing Address - Fax:408-292-3330
Practice Address - Street 1:660 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1931
Practice Address - Country:US
Practice Address - Phone:408-292-2485
Practice Address - Fax:408-292-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4689213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E46890Medicaid
CAZZZ07519ZMedicare PIN
CA000E46890Medicaid