MEDICARE: DIANA NGOC NGUYEN 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
1	363AM0700X	Medical Physician Assistant	PA23066	CA

General Provider Information

NPI Number	:	1861834400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA NGOC NGUYEN PA-C

Provider Business Mailing Address
First Line	:	667 N WHITE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-1447
Country	:	US
Telephone Number	:	408-646-8590
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 N WHITE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-1447
Country	:	US
Telephone Number	:	408-646-8590
Fax Number	:

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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