Provider Demographics
NPI:1770544546
Name:NGUYEN, KIM-LIEN (MD)
Entity type:Individual
Prefix:DR
First Name:KIM-LIEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2866
Mailing Address - Country:US
Mailing Address - Phone:610-370-9360
Mailing Address - Fax:610-370-9325
Practice Address - Street 1:130 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2866
Practice Address - Country:US
Practice Address - Phone:610-370-9360
Practice Address - Fax:610-370-9325
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-051224-L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232840903OtherTIN
PA232840903OtherTIN
PANG574629Medicare ID - Type Unspecified