MEDICARE: DR. NINA HONG QUYEN LA D.C., L.AC.

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	111N00000X	Chiropractor	31581	CA
2	171100000X	Acupuncturist	13214	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DY495A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1053628727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINA HONG QUYEN LA D.C., L.AC.

Provider Business Mailing Address
First Line	:	17122 BEACH BLVD STE 100
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5992
Country	:	US
Telephone Number	:	714-681-2811
Fax Number	:	855-260-8190

Provider Business Practice Location Address
First Line	:	17122 BEACH BLVD STE 100
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5992
Country	:	US
Telephone Number	:	714-681-2811
Fax Number	:	855-260-8190

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	10/30/2012

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