Provider Demographics
NPI:1376517821
Name:NGUYEN, KIMBERLY KIEU (DMD, PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KIEU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 E HARRY ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5089
Mailing Address - Country:US
Mailing Address - Phone:316-612-7777
Mailing Address - Fax:316-612-7788
Practice Address - Street 1:9415 E HARRY ST
Practice Address - Street 2:SUITE 606
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5089
Practice Address - Country:US
Practice Address - Phone:316-612-7777
Practice Address - Fax:316-612-7788
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS986358OtherUNITED CONCORDIA
KS116500OtherBLUE CROSS BLUE SHIELD