MEDICARE: ENT AND SINUS CENTER P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	G83603	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043409022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT AND SINUS CENTER P C

Provider Business Mailing Address
First Line	:	1800 MEDICAL CENTER DR
Second Line	:	SUITE 105
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1218
Country	:	US
Telephone Number	:	909-880-2000
Fax Number	:	909-880-1102

Provider Business Practice Location Address
First Line	:	1800 MEDICAL CENTER DR
Second Line	:	SUITE 105
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1218
Country	:	US
Telephone Number	:	909-880-2000
Fax Number	:	909-880-1102

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. HENRY HUY NGUYEN
Credential	:	M.D.
Telephone Number	:	909-880-2000

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	03/05/2009

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Directions to “ENT AND SINUS CENTER P C ” Practice Location

Language	Start Address	Practice Location

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