1013953397 NPI number — KIM-DUNG T NGUYEN M.D.

Table of content: KIM-DUNG T NGUYEN M.D. (NPI 1013953397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013953397 NPI number — KIM-DUNG T NGUYEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
KIM-DUNG
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
KIM
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013953397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11193
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22312-0193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-823-2849
Provider Business Mailing Address Fax Number:
703-823-2847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5130 DUKE ST
Provider Second Line Business Practice Location Address:
8
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-823-2849
Provider Business Practice Location Address Fax Number:
703-823-2847
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101226147 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 031903700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5849543 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".