Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A142734 | CA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD-46065 | IA |
NPI | 1093134173 |
---|---|
Provider Name | Khanh K Nguyen |
First Address | Loma Linda, CA 92354-2804 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 13/07/2020 |