Provider Demographics
NPI:1598739203
Name:NGUYEN, KEVIN KHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KHUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:KHUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1342
Mailing Address - Country:US
Mailing Address - Phone:951-704-5771
Mailing Address - Fax:951-672-6132
Practice Address - Street 1:29798 HAUN ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586
Practice Address - Country:US
Practice Address - Phone:951-301-9188
Practice Address - Fax:951-672-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC603AMedicare PIN