MEDICARE: BACH VAN NGUYEN, M.D, P.C.

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	MD039485L	PA

General Provider Information

NPI Number	:	1578928040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACH VAN NGUYEN, M.D, P.C.

Provider Business Mailing Address
First Line	:	828 SNYDER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2310
Country	:	US
Telephone Number	:	215-755-8220
Fax Number	:	215-755-8692

Provider Business Practice Location Address
First Line	:	828 SNYDER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2310
Country	:	US
Telephone Number	:	215-755-8220
Fax Number	:	215-755-8692

Authorized Official
Title or Position	:	OWNER
Name	:	BACH V NGUYEN
Credential	:	M.D.
Telephone Number	:	215-755-8220

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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