Provider Demographics
NPI:1700633666
Name:NGUYEN, KEVIN VAN (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:510 SUPERIOR AVE STE 200F
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 SUPERIOR AVE STE 200F
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3664
Practice Address - Country:US
Practice Address - Phone:949-999-8979
Practice Address - Fax:949-999-8970
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA63572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant