MEDICARE: LN SURGERY CLINIC

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	261Q00000X	Clinic/Center	A45981	CA

General Provider Information

NPI Number	:	1073862058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LN SURGERY CLINIC

Provider Business Mailing Address
First Line	:	13071 BROOKHURST ST
Second Line	:	SUITE # 160
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1091
Country	:	US
Telephone Number	:	714-636-8196
Fax Number	:	714-636-8197

Provider Business Practice Location Address
First Line	:	13071 BROOKHURST ST
Second Line	:	SUITE # 160
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1091
Country	:	US
Telephone Number	:	714-636-8196
Fax Number	:	714-636-8197

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAN KHAC NGUYEN
Credential	:	M.D.
Telephone Number	:	714-636-8196

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/05/2012

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