Provider Demographics
NPI:1457557472
Name:NGUYEN, KIM ANH (OD)
Entity type:Individual
Prefix:DR
First Name:KIM ANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15622 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7573
Mailing Address - Country:US
Mailing Address - Phone:714-657-3124
Mailing Address - Fax:714-775-4518
Practice Address - Street 1:15622 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7573
Practice Address - Country:US
Practice Address - Phone:714-657-3124
Practice Address - Fax:714-775-4518
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9324T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0093242Medicaid
CASD0093242Medicaid