Provider Demographics
NPI:1326455007
Name:NGUYEN, KIM-DAN PHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM-DAN
Middle Name:PHAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17202 CLAY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4291
Mailing Address - Country:US
Mailing Address - Phone:281-886-7063
Mailing Address - Fax:
Practice Address - Street 1:17202 CLAY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4291
Practice Address - Country:US
Practice Address - Phone:281-886-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8429T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist