Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 56195 | TN |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A128602 | CA |
NPI | 1609111665 |
---|---|
Provider Name | Jacqueline Kim Nguyen |
First Address | Napa, CA 94558-3328 |
Second Address | Napa, CA 94558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2012 |
Last Update Date | 21/08/2018 |