MEDICARE: SK NGUYEN PLLC

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	PA1379	NV

General Provider Information

NPI Number	:	1841679313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SK NGUYEN PLLC

Provider Business Mailing Address
First Line	:	2057 CHERRY CREEK CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1567
Country	:	US
Telephone Number	:	702-743-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	6539 LAS VEGAS BLVD S
Second Line	:	SUITE 111
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3222
Country	:	US
Telephone Number	:	702-501-1033
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH NGUYEN
Credential	:	PA-C
Telephone Number	:	702-501-1033

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	05/29/2015

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