Provider Demographics
NPI:1871164855
Name:DR KIM ANH NGUYEN LLC
Entity type:Organization
Organization Name:DR KIM ANH NGUYEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-763-2002
Mailing Address - Street 1:5920 S RAINBOW BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4209
Mailing Address - Country:US
Mailing Address - Phone:702-763-2002
Mailing Address - Fax:877-414-2638
Practice Address - Street 1:5920 S RAINBOW BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4209
Practice Address - Country:US
Practice Address - Phone:702-763-2002
Practice Address - Fax:877-414-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1871164855Medicaid
NV1700030954Medicaid
NVDO2258OtherMEDICAL LICENSE