Provider Demographics
NPI:1689934473
Name:NGUYEN KY DPM INC
Entity Type:Organization
Organization Name:NGUYEN KY DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-292-2485
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:660 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1931
Practice Address - Country:US
Practice Address - Phone:408-292-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NGUYEN KY DPM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site