Provider Demographics
NPI:1295815991
Name:NGUYEN, KIM LOAN (DDS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:LOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 ELDRIDGE PARKWAY
Mailing Address - Street 2:STE 170
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:281-759-1277
Mailing Address - Fax:281-759-1557
Practice Address - Street 1:1560 ELDRIDGE PARKWAY
Practice Address - Street 2:STE 170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077
Practice Address - Country:US
Practice Address - Phone:281-759-1277
Practice Address - Fax:281-759-1557
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138358012Medicaid