Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1235467 | CA |
NPI | 1649624107 |
---|---|
Provider Name | Kim Nguyen |
First Address | San Jose, CA 95136 |
Second Address | San Jose, CA 95136-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 05/05/2017 |