Provider Demographics
NPI:1891365938
Name:NGUYEN, KIMMIE HUYNH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMMIE
Middle Name:HUYNH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7543 HOOES RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4425
Mailing Address - Country:US
Mailing Address - Phone:703-472-8724
Mailing Address - Fax:
Practice Address - Street 1:1201 I ST NW STE 110A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-6004
Practice Address - Country:US
Practice Address - Phone:202-315-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist