Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401410611 | VA |
N | 122300000X | Dentist | 13049 | MD |
NPI | 1003042748 |
---|---|
Provider Name | Dr. Kristina T Nguyen |
First Address | Mc Lean, VA 22102-3813 |
Second Address | Mc Lean, VA 22102-3813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 09/06/2009 |