Provider Demographics
NPI:1871956474
Name:NGUYEN, KHANH N (DC)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 DESSAU RIDGE LN
Mailing Address - Street 2:APT 702
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-2122
Mailing Address - Country:US
Mailing Address - Phone:512-840-0119
Mailing Address - Fax:877-509-5308
Practice Address - Street 1:1508 DESSAU RIDGE LN
Practice Address - Street 2:APT 702
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-2122
Practice Address - Country:US
Practice Address - Phone:512-840-0119
Practice Address - Fax:877-509-5308
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor