Provider Demographics
NPI:1114109071
Name:NGUYEN, TIMOTHY TRUNG (LAC, DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:TRUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
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Mailing Address - Street 1:600 ALA MOANA BLVD APT 2502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4959
Mailing Address - Country:US
Mailing Address - Phone:808-319-7791
Mailing Address - Fax:808-200-0567
Practice Address - Street 1:1150 S KING ST STE 302
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1951
Practice Address - Country:US
Practice Address - Phone:808-319-7791
Practice Address - Fax:808-200-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC11658171100000X
HIACU1213171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist