MEDICARE: VAN NGUYEN MD, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1649453143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN NGUYEN MD, LLC

Provider Business Mailing Address
First Line	:	232 LONG LN
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 LONG LN
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3909
Country	:	US
Telephone Number	:	610-457-8201
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VAN NGUYEN
Credential	:
Telephone Number	:	610-457-8201

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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