1669745782 NPI number — DR. THIEN KIM NGUYEN VUONG O.D.

Table of content: DR. THIEN KIM NGUYEN VUONG O.D. (NPI 1669745782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669745782 NPI number — DR. THIEN KIM NGUYEN VUONG O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VUONG
Provider First Name:
THIEN KIM
Provider Middle Name:
NGUYEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.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:
THIEN KIM
Provider Other Middle Name:
TRAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669745782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4280 EAST WEST CONNECTOR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30082-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-486-2000
Provider Business Mailing Address Fax Number:
559-256-8575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7075 N SHARON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-486-2000
Provider Business Practice Location Address Fax Number:
559-256-8575
Provider Enumeration Date:
02/21/2012

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: 152W00000X , with the licence number:  1826 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 003273 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 15154 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1826 . This is a "AZ STATE BOARD OF OPTOMETRY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".