Provider Demographics
NPI:1447502786
Name:NGUYEN, KHOA DANG (OD)
Entity type:Individual
Prefix:
First Name:KHOA
Middle Name:DANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 383147
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-3147
Mailing Address - Country:US
Mailing Address - Phone:808-883-3767
Mailing Address - Fax:808-319-2510
Practice Address - Street 1:68-1845 WAIKOLOA RD STE 218
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5584
Practice Address - Country:US
Practice Address - Phone:808-883-3767
Practice Address - Fax:808-319-2510
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist