Provider Demographics
NPI:1518159037
Name:NGUYEN, KIM LOAN T (MD)
Entity Type:Individual
Prefix:MS
First Name:KIM LOAN
Middle Name:T
Last Name:NGUYEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:269-349-0792
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:269-349-2266
Practice Address - Fax:269-349-0792
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2022-01-07
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Provider Licenses
StateLicense IDTaxonomies
MIKN080415207RG0100X
GA067515207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003913802OtherBLUE CROSS BLUE SHIELD
MI1851569958OtherNPI FOR DIGESTIVE HEALTH ASSOCIATE
MI261859452OtherTAX ID FOR DIGESTIVE HEALTH ASSOCIATES OF SW MI
MI4301080415OtherSTATE LICENSE NUMBER
MI105371914Medicaid
MI0P56360007Medicare PIN