Provider Demographics
NPI:1093045833
Name:NGUYEN-CASEY, KIM PHUONG LUCY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIM PHUONG
Middle Name:LUCY
Last Name:NGUYEN-CASEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:NGUYEN-CASEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2921 DE LA VINA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3309
Mailing Address - Country:US
Mailing Address - Phone:408-603-3156
Mailing Address - Fax:
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-682-6455
Practice Address - Fax:805-687-1482
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21330363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant