Provider Demographics
NPI:1982990065
Name:NGUYEN, KIM-PHUNG THI (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM-PHUNG
Middle Name:THI
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 1:3000 MEDICAL PARK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6600
Mailing Address - Country:US
Mailing Address - Phone:813-615-7030
Mailing Address - Fax:813-615-8350
Practice Address - Street 1:3000 MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6600
Practice Address - Country:US
Practice Address - Phone:813-615-7030
Practice Address - Fax:813-615-8350
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016860390200000X
FLME127435390200000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program