Provider Demographics
NPI:1871643460
Name:NGUYEN, PHUNG KIM (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PHUNG
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:PHUNG
Other - Middle Name:KIM
Other - Last Name:TANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:808 N BUNKER HILL AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1696
Mailing Address - Country:US
Mailing Address - Phone:213-613-1044
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:HEALTH SCREENING AND EDUCATION CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-913-4817
Practice Address - Fax:323-913-4928
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily