Provider Demographics
NPI:1356639025
Name:HO, KIM THIEN NGUYEN (AUD)
Entity Type:Individual
Prefix:
First Name:KIM THIEN
Middle Name:NGUYEN
Last Name:HO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:STE 1400
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4205
Mailing Address - Country:US
Mailing Address - Phone:864-278-1442
Mailing Address - Fax:864-278-1255
Practice Address - Street 1:200 S HERLONG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3399
Practice Address - Country:US
Practice Address - Phone:803-328-1864
Practice Address - Fax:803-328-1865
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3981231H00000X
NC10936231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19ABJOtherBCBSNC
SCP01479711OtherRAILROAD MEDICARE SC
1510229OtherAETNA/COVENTRY
7501035OtherCIGNA
SCSA1517Medicaid
NC19ABJOtherBCBSNC
SCSA1517Medicaid