MEDICARE: AMY NGOC 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	207Q00000X	Family Medicine Physician	A80879	CA
2	207N00000X	Dermatology Physician	A80879	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

General Provider Information

NPI Number	:	1548274996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY NGOC NGUYEN MD

Provider Business Mailing Address
First Line	:	2720 N HARBOR BLVD STE 205
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2974
Country	:	US
Telephone Number	:	714-882-5525
Fax Number	:	714-882-5078

Provider Business Practice Location Address
First Line	:	2720 N HARBOR BLVD STE 205
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-2609
Country	:	US
Telephone Number	:	714-882-5525
Fax Number	:	714-882-5078

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	05/23/2026

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