Provider Demographics
NPI:1528605466
Name:NGUYEN, KOBI
Entity Type:Individual
Prefix:
First Name:KOBI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 KIMBLEWYCK CIR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-6126
Mailing Address - Country:US
Mailing Address - Phone:303-931-3787
Mailing Address - Fax:
Practice Address - Street 1:7211 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4901
Practice Address - Country:US
Practice Address - Phone:303-931-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4129183500000X
CO22615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist