Provider Demographics
NPI:1912009929
Name:NGUYEN, LINHKIEU THI
Entity Type:Individual
Prefix:DR
First Name:LINHKIEU
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LINHKIEU
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3575 EUCLID AVENUE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-0000
Mailing Address - Country:US
Mailing Address - Phone:619-284-1400
Mailing Address - Fax:619-384-1113
Practice Address - Street 1:3575 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-284-1400
Practice Address - Fax:619-284-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A838860Medicaid
CA00A838860Medicaid
CAH95413Medicare UPIN