MEDICARE: BAO ANH LE NGUYEN M.D.

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	A89126	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	:	1588673024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAO ANH LE NGUYEN M.D.

Provider Business Mailing Address
First Line	:	1441 E VIA VERDE DR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-8806
Country	:	US
Telephone Number	:	559-478-7017
Fax Number	:	559-433-0443

Provider Business Practice Location Address
First Line	:	1441 E VIA VERDE DR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-8806
Country	:	US
Telephone Number	:	559-478-7017
Fax Number	:	559-433-0443

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	01/19/2022

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