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General NPI Number Information
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NPI Number | 1073815098
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Entity Type | Organization
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Legal Business Name | HUNG-ANH BA NGUYEN, M.D., INC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 2828 MILLS PARK DR STE D
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-4711
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Country | US
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Telephone | 916-858-8515
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Fax | 916-858-8246
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Provider Business Mailing Address
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Address Line | 2828 MILLS PARK DR STE D
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-4711
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Country | US
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Telephone | 916-858-8515
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Fax | 916-858-8246
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Authorized Official
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Title or Position | OWNER
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Name | HUNG-ANH BA NGUYEN
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Credential | M.D.
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Telephone | 916-858-8515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0061059
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License Number State | MD
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