Provider Demographics
NPI:1720203516
Name:NGUYEN, KEVIN UYLIEM (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:UYLIEM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1304
Mailing Address - Country:US
Mailing Address - Phone:818-782-0888
Mailing Address - Fax:818-782-8999
Practice Address - Street 1:6411 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1N
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1304
Practice Address - Country:US
Practice Address - Phone:818-782-0888
Practice Address - Fax:818-782-8999
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU73410Medicare UPIN