Provider Demographics
NPI:1609262344
Name:NGUYEN, KIM THI (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 EAST MANOA RD.
Mailing Address - Street 2:STE 105 PMB 171
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1854
Mailing Address - Country:US
Mailing Address - Phone:808-792-0988
Mailing Address - Fax:970-230-6414
Practice Address - Street 1:111 HEKILI ST # A239
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2800
Practice Address - Country:US
Practice Address - Phone:808-792-0988
Practice Address - Fax:970-230-6414
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00637172084P0800X, 2084P0804X
HIMD-215842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry