Provider Demographics
NPI:1083242077
Name:NGUYEN-TA, KIM THANH (MD, MS, MPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:THANH
Last Name:NGUYEN-TA
Suffix:
Gender:F
Credentials:MD, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10038 KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3581
Mailing Address - Country:US
Mailing Address - Phone:858-876-5430
Mailing Address - Fax:
Practice Address - Street 1:9300 CAMPUS POINT DR # MC7220
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program