| Doctor Name: | KAITLYN PHUONG NGUYEN |
| NPI Number: | 1043590250 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.C. |
| License Number: | PA21641 |
| Business Practice Address: | 17220 Newhope St #125 Fountain Valley, CA - 927084272 |
| Business Phone Number: | 7144350600 |
| Business Fax Number: | |
| Mailing Address: | 17220 Newhope St, #125 FOUNTAIN VALLEY |
| State: | CA |
| Postal Code: | 927084272 |
| Phone Number: | 7144350600 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2011 |
| NPI Last Update Date: | 05/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA21641 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |