Active NPI
Lien Thi Kim Nguyen, O.D.
- Optometrist
- Lodi, CA
National Provider Identifier
1124066931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12471 T
- Practice address
- 400 E Kettleman LN
Suite #18
Lodi, CA 95240-5962 - Phone
- (209) 333-2221
- Fax
- (209) 333-7771
- NPI assigned
- Jun 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12471 T | CA | Primary |
Addresses
Primary practice location
400 E Kettleman LN
Suite #18
Lodi, CA 95240-5962
Mailing address
9668 Ashstone Way
Elk Grove, CA 95624-4712
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040203000910 | CA | Practitioner - Optometry | 7113810201 | Practice locations: Lodi, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12471 T | CA | MD | Optometrist |
| 12471 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263945600000",
"number": "1124066931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9668 ASHSTONE WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956244712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E KETTLEMAN LN",
"address_2": "SUITE #18",
"city": "LODI",
"state": "CA",
"postal_code": "952405962",
"telephone_number": "209-333-2221",
"fax_number": "209-333-7771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "LIEN",
"middle_name": "THI KIM",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-03",
"last_updated": "2010-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12471 T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.