Provider Demographics
NPI:1942235734
Name:NGUYEN, BACH-KIM (OD)
Entity Type:Individual
Prefix:DR
First Name:BACH-KIM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4962
Mailing Address - Country:US
Mailing Address - Phone:925-934-4313
Mailing Address - Fax:925-943-1907
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:SUITE 312
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-934-4313
Practice Address - Fax:925-943-1907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10544T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68041-2896OtherEIN
CASD0105440Medicare ID - Type Unspecified
CAU59182Medicare UPIN