MEDICARE: JONATHAN NGUYEN MEDICAL CLINIC INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1144864992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN NGUYEN MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	555 E PACIFIC COAST HWY STE 102
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5579
Country	:	US
Telephone Number	:	562-591-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 E PACIFIC COAST HWY STE 102
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5579
Country	:	US
Telephone Number	:	562-591-3222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN TUAN NGUYEN
Credential	:	MD
Telephone Number	:	562-591-3222

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	01/20/2020

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