Provider Demographics
NPI:1154196723
Name:NGUYEN, KIMMY (PA-C)
Entity type:Individual
Prefix:
First Name:KIMMY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13632 PALOMAR ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3022
Mailing Address - Country:US
Mailing Address - Phone:714-514-7259
Mailing Address - Fax:
Practice Address - Street 1:9710 19TH ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3538
Practice Address - Country:US
Practice Address - Phone:909-581-0008
Practice Address - Fax:909-581-0030
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-23
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant