Active NPI
Kim Thi Nguyen, M.D.
- Child & Adolescent Psychiatry Physician
- Kailua, HI
National Provider Identifier
1609262344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- DR.0063717
- Practice address
- 111 Hekili St # A239
Kailua, HI 96734-2800 - Phone
- (808) 792-0988
- Fax
- (970) 230-6414
- NPI assigned
- Apr 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | DR.0063717 | CO | |
| Psychiatry Physician | 2084P0800X | MD-21584 | HI | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | DR.0063717 | CO | Primary |
Addresses
Primary practice location
111 Hekili St # A239
Kailua, HI 96734-2800
Mailing address
2855 East Manoa Rd.
Ste 105 PMB 171
Honolulu, HI 96822-1854
Phone (808) 792-0988
Other practice location 1
100 West Beaver Creek Blvd.
Suite 208
Avon, CO 81620
Phone (970) 340-8159
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 14, 2020 through Dec 14, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR.0063717 | CO | MD | Psychiatry Physician |
| MD-21584 | HI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627084800000",
"number": "1609262344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2855 EAST MANOA RD.",
"address_2": "STE 105 PMB 171",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968221854",
"telephone_number": "808-792-0988",
"fax_number": "970-230-6414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 HEKILI ST # A239",
"city": "KAILUA",
"state": "HI",
"postal_code": "967342800",
"telephone_number": "808-792-0988",
"fax_number": "970-230-6414"
}
],
"practiceLocations": [
{
"address_1": "100 West Beaver Creek Blvd.",
"address_2": "Suite 208",
"address_purpose": "LOCATION",
"city": "Avon",
"state": "CO",
"postal_code": "81620",
"country_code": "US",
"telephone_number": "970-340-8159",
"fax_number": "970-230-6414",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NGUYEN",
"first_name": "KIM",
"middle_name": "THI",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-09",
"last_updated": "2021-07-24",
"certification_date": "2021-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CO",
"license": "DR.0063717",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "HI",
"license": "MD-21584",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CO",
"license": "DR.0063717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kailua, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.