Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT213508 | PA |
Y | 2080P0201X | Pediatric Allergist | MT213508 | PA |
NPI | 1548792203 |
---|---|
Provider Name | Dr. Kim Nguyen |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2017 |
Last Update Date | 26/06/2020 |