Provider Demographics
NPI:1053006742
Name:NGUYEN, KEVIN-KHOA ANH (FNP-C)
Entity type:Individual
Prefix:
First Name:KEVIN-KHOA
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 MOUNTAIN HOME DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1217
Mailing Address - Country:US
Mailing Address - Phone:408-425-9521
Mailing Address - Fax:
Practice Address - Street 1:519 MOUNTAIN HOME DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1217
Practice Address - Country:US
Practice Address - Phone:408-425-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily