Basic Information
| Provider Information | |||||||||
| NPI: | 1356639025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | KIM THIEN | ||||||||
| MiddleName: | NGUYEN | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 BOILING SPRINGS RD | ||||||||
| Address2: | STE 1400 | ||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293034205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642781442 | ||||||||
| FaxNumber: | 8642781255 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S HERLONG AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297323399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033281864 | ||||||||
| FaxNumber: | 8033281865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2011 | ||||||||
| LastUpdateDate: | 05/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 3981 | SC | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 10936 | NC | N | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 19ABJ | 01 | NC | BCBSNC | OTHER | P01479711 | 01 | SC | RAILROAD MEDICARE SC | OTHER | 1510229 | 01 | AETNA/COVENTRY | OTHER | 7501035 | 01 | CIGNA | OTHER | SA1517 | 05 | SC | MEDICAID |