Provider Demographics
NPI:1891994547
Name:KIM-DUNG T. NGUYEN, MD, PC
Entity Type:Organization
Organization Name:KIM-DUNG T. NGUYEN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-538-2200
Mailing Address - Street 1:PO BOX 11193
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-0193
Mailing Address - Country:US
Mailing Address - Phone:703-538-2200
Mailing Address - Fax:703-823-2847
Practice Address - Street 1:5130 DUKE ST
Practice Address - Street 2:8
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2924
Practice Address - Country:US
Practice Address - Phone:703-823-2849
Practice Address - Fax:703-823-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5849543Medicaid
H35010Medicare UPIN
490808Medicare PIN