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NPI Code Detail

MEDICARE: IVY NGUYEN MD

MEDICARE: IVY NGUYEN MD
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
12084N0400XNeurology PhysicianA141143CA

General Provider Information

NPI Number : 1053739425
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVY NGUYEN MD
Provider Business Mailing Address
First Line : 4860 Y ST STE 3700
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-2307
Country : US
Telephone Number : 916-734-6285
Fax Number :
Provider Business Practice Location Address
First Line : 3160 FOLSOM BLVD STE 2100
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-5266
Country : US
Telephone Number : 916-734-3588
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2014
Last Update Date : 11/19/2021

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