Active NPI
Kenny Nguyen, MD
- Student in an Organized Health Care Education/Training Program
- Jacksonville, FL
National Provider Identifier
1558058529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 655 W 8TH St # C90
Jacksonville, FL 32209-6511 - Phone
- (904) 244-4230
- NPI assigned
- Apr 20, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | SC | Primary |
Addresses
Primary practice location
655 W 8TH St # C90
Jacksonville, FL 32209-6511
Mailing address
145 Sunset CT Ste 100
West Columbia, SC 29169-2429
Phone (803) 739-3550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230724003960 | SC | Order and Referring Only - Internal Medicine | 9537529409 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711152000000",
"number": "1558058529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 SUNSET CT STE 100",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291692429",
"telephone_number": "803-739-3550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 W 8TH ST # C90",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322096511",
"telephone_number": "904-244-4230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "KENNY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-20",
"last_updated": "2024-03-23",
"certification_date": "2024-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "SC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2024; 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.