Provider Demographics
NPI:1255778072
Name:NGUYEN, KIET THUONG (DC)
Entity type:Individual
Prefix:
First Name:KIET
Middle Name:THUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 THORN AVE
Mailing Address - Street 2:# B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1743
Mailing Address - Country:US
Mailing Address - Phone:714-675-3048
Mailing Address - Fax:
Practice Address - Street 1:936 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4519
Practice Address - Country:US
Practice Address - Phone:714-675-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor