Provider Demographics
NPI:1518567262
Name:NGUYEN, KATHY TRAM (BA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:TRAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4179
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-4179
Mailing Address - Country:US
Mailing Address - Phone:714-726-3712
Mailing Address - Fax:
Practice Address - Street 1:12570 BROOKHURST ST STE 2
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4882
Practice Address - Country:US
Practice Address - Phone:714-726-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician