Provider Demographics
NPI:1558575589
Name:NGUYEN, CHI KIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781
Mailing Address - Country:US
Mailing Address - Phone:727-545-9590
Mailing Address - Fax:727-548-8590
Practice Address - Street 1:5265 PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3451
Practice Address - Country:US
Practice Address - Phone:727-545-9590
Practice Address - Fax:727-548-8590
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist