Provider Demographics
NPI:1013953397
Name:NGUYEN, KIM-DUNG T (MD)
Entity Type:Individual
Prefix:
First Name:KIM-DUNG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:D
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:703-823-2849
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC031903700Medicaid
VA5849543Medicaid
VA5849543Medicaid
DC031903700Medicaid