MEDICARE: NICOLE VU HIEN 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	208100000X	Physical Medicine & Rehabilitation Physician	OP61411798	WA
2	208100000X	Physical Medicine & Rehabilitation Physician	23451	CA

General Provider Information

NPI Number	:	1407317886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VU HIEN NGUYEN DO

Provider Business Mailing Address
First Line	:	PO BOX 7410882
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0882
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	3520 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4913
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	10/10/2025

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Directions to “ NICOLE VU HIEN NGUYEN DO” Practice Location

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