Provider Demographics
NPI:1295213197
Name:NGUYEN, JIMMY LIEM (RCP)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:LIEM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10437 ANDASOL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6035
Mailing Address - Country:US
Mailing Address - Phone:661-309-8448
Mailing Address - Fax:
Practice Address - Street 1:1505 N EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5209
Practice Address - Country:US
Practice Address - Phone:323-783-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27276227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27276OtherRESPIRATORY CARE BOARD OF CALIFORNIA