MEDICARE: MR. VIET NGUYEN M.D.

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	174400000X	Specialist	5151398-8905	UT

General Provider Information

NPI Number	:	1063470136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIET NGUYEN M.D.

Provider Business Mailing Address
First Line	:	1612 UTE BLVD
Second Line	:	112
City	:	PARK CITY
State	:	UT
Zip	:	84098-7500
Country	:	US
Telephone Number	:	435-655-3309
Fax Number	:	435-655-3392

Provider Business Practice Location Address
First Line	:	1612 UTE BLVD
Second Line	:	112
City	:	PARK CITY
State	:	UT
Zip	:	84098-7500
Country	:	US
Telephone Number	:	435-655-3309
Fax Number	:	435-655-3392

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/02/2007

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