Provider Demographics
NPI:1871634022
Name:NGUYEN, VAN KHANH (FITTER)
Entity Type:Individual
Prefix:MRS
First Name:VAN
Middle Name:KHANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BON AIR RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1141
Mailing Address - Country:US
Mailing Address - Phone:415-924-2454
Mailing Address - Fax:415-924-1015
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1141
Practice Address - Country:US
Practice Address - Phone:415-924-2454
Practice Address - Fax:415-924-1015
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist