MEDICARE: NGUYEN CLARK & ASSOCIATES

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1083919294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NGUYEN CLARK & ASSOCIATES

Provider Business Mailing Address
First Line	:	3848 CAMPUS DR STE 108
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3848 CAMPUS DR STE 108
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2655
Country	:	US
Telephone Number	:	949-400-8342
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HANH NGUYEN
Credential	:	D.O.
Telephone Number	:	949-400-8342

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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