Provider Demographics
NPI:1265590897
Name:NGUYEN, KHANG THAI (MD)
Entity type:Individual
Prefix:
First Name:KHANG
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KARL
Other - Middle Name:THAI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2775 VIA DE LA VALLE
Mailing Address - Street 2:101
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1921
Mailing Address - Country:US
Mailing Address - Phone:858-869-7729
Mailing Address - Fax:888-347-0124
Practice Address - Street 1:2775 VIA DE LA VALLE
Practice Address - Street 2:101
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1921
Practice Address - Country:US
Practice Address - Phone:858-869-7729
Practice Address - Fax:888-347-0124
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90876208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery