Provider Demographics
NPI:1396769196
Name:NGUYEN, KHOA KE (DC)
Entity type:Individual
Prefix:DR
First Name:KHOA
Middle Name:KE
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 1:110 S PARK VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5724
Mailing Address - Country:US
Mailing Address - Phone:408-945-9495
Mailing Address - Fax:408-586-9420
Practice Address - Street 1:110 S PARK VICTORIA DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5724
Practice Address - Country:US
Practice Address - Phone:408-945-9495
Practice Address - Fax:408-586-9420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0259110Medicare ID - Type Unspecified