Provider Demographics
NPI:1235858655
Name:NGUYEN, NHAT-QUYNH KIM (OD)
Entity Type:Individual
Prefix:
First Name:NHAT-QUYNH
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:QUYNH
Other - Middle Name:KIM
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4414 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3326
Mailing Address - Country:US
Mailing Address - Phone:206-446-7831
Mailing Address - Fax:
Practice Address - Street 1:9720 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2143
Practice Address - Country:US
Practice Address - Phone:206-302-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35184152W00000X
WAOD61422638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist