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NPI Code Detail

MEDICARE: NGOC-LIEN NGUYEN-GRAHAM PA-C

MEDICARE: NGOC-LIEN NGUYEN-GRAHAM PA-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
1363A00000XPhysician Assistant1500684KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750372512
Entity Type Code : Individual
Provider Name (Legal Business Name) : NGOC-LIEN NGUYEN-GRAHAM PA-C
Provider Business Mailing Address
First Line : PO BOX 8035
Second Line :
City : WICHITA
State : KS
Zip : 67208-0035
Country : US
Telephone Number : 316-689-9135
Fax Number : 316-689-9667
Provider Business Practice Location Address
First Line : 1947 N FOUNDERS CIR
Second Line :
City : WICHITA
State : KS
Zip : 67206-3548
Country : US
Telephone Number : 316-613-4760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 05/21/2020

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Directions to “ NGOC-LIEN NGUYEN-GRAHAM PA-C” Practice Location

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