MEDICARE: HENNY THI NGUYEN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E4067	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E4067	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1568466001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENNY THI NGUYEN DPM

Provider Business Mailing Address
First Line	:	14360 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4608
Country	:	US
Telephone Number	:	714-531-9682
Fax Number	:	714-531-9686

Provider Business Practice Location Address
First Line	:	14360 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4608
Country	:	US
Telephone Number	:	714-531-9682
Fax Number	:	714-531-9686

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	12/24/2007

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