MEDICARE: DR. TUAN D NGUYEN DO

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	S4200	TX
2	208D00000X	General Practice Physician	S4200	TX
3	207RN0300X	Nephrology Physician	20A18461	CA

General Provider Information

NPI Number	:	1164959185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUAN D NGUYEN DO

Provider Business Mailing Address
First Line	:	4502 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9126 VALLEY BLVD STE B
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-1987
Country	:	US
Telephone Number	:	626-573-9003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	08/22/2024

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