MEDICARE: LI Q. 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
1	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1063166817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LI Q. NGUYEN, MD

Provider Business Mailing Address
First Line	:	10760 WARNER AVE STE 201
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3857
Country	:	US
Telephone Number	:	714-593-5356
Fax Number	:	714-593-5366

Provider Business Practice Location Address
First Line	:	10760 WARNER AVE STE 201
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3857
Country	:	US
Telephone Number	:	714-593-5356
Fax Number	:	714-593-5366

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LI NGUYEN
Credential	:	MD
Telephone Number	:	714-593-5356

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	07/12/2022

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