Individual provider Active NPI

Krystal Diem Trang Nguyen, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1073822359
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14047 Issued in CA
Practice address
4281 W 3Rd St
Los Angeles, CA 90020
Phone
(213) 383-0383
Fax
(213) 383-3858
NPI assigned
Oct 4, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14047 CA Primary

Addresses

Primary practice location

4281 W 3Rd St
Los Angeles, CA 90020

Mailing address

4281 W 3Rd St
Los Angeles, CA 90020-3448
Phone (213) 383-0383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260331002711 CA Order and Referring Only - OptometryPractitioner - Optometry 3072795608

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1073822359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4281 W 3RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900203448",
            "telephone_number": "213-383-0383",
            "fax_number": "213-383-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4281 W 3RD ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90020",
            "telephone_number": "213-383-0383",
            "fax_number": "213-383-3858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KRYSTAL",
        "middle_name": "DIEM TRANG",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-04",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.