MEDICARE: DR. MAI PHUONG THI NGUYEN MD

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	A61956	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
2	1265450266	OTHER	CA	NPI

General Provider Information

NPI Number	:	1265450266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAI PHUONG THI NGUYEN MD

Provider Business Mailing Address
First Line	:	16027 BROOKHURST ST # G110
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1551
Country	:	US
Telephone Number	:	707-225-7031
Fax Number	:	714-531-1006

Provider Business Practice Location Address
First Line	:	16027 BROOKHURST ST # I-110
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1551
Country	:	US
Telephone Number	:	844-527-8620
Fax Number	:	844-342-5278

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/14/2021

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