Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002024500 | CO |
NPI | 1013460138 |
---|---|
Provider Name | Kimanh Thi Nguyen |
First Address | Lafayette, CO 80026-7093 |
Second Address | Thornton, CO 80229-4537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 05/06/2020 |