Provider Demographics
NPI:1922168715
Name:NGUYEN, LOAN KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:LOAN
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3709
Mailing Address - Country:US
Mailing Address - Phone:559-432-1000
Mailing Address - Fax:559-432-1034
Practice Address - Street 1:6767 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3709
Practice Address - Country:US
Practice Address - Phone:559-432-1000
Practice Address - Fax:559-432-1034
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA509810207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A509810Medicaid
CAA509810OtherLICENSE#
CAA509810OtherLICENSE#
CA00A509810Medicaid