Provider Demographics
NPI:1457419822
Name:NGUYEN, KIM-THOA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM-THOA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 LONG BEACH BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5501
Mailing Address - Country:US
Mailing Address - Phone:562-588-9401
Mailing Address - Fax:562-218-0402
Practice Address - Street 1:1975 LONG BEACH BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5501
Practice Address - Country:US
Practice Address - Phone:562-588-9401
Practice Address - Fax:562-218-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS206841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical