MEDICARE: LUONG NGUYEN D.O

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	207Q00000X	Family Medicine Physician	20A7102	CA

General Provider Information

NPI Number	:	1144254228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUONG NGUYEN D.O

Provider Business Mailing Address
First Line	:	425 N DATE ST
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3413
Country	:	US
Telephone Number	:	760-737-2035
Fax Number	:	760-741-2782

Provider Business Practice Location Address
First Line	:	16650 HIGHWAY 76
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061-9524
Country	:	US
Telephone Number	:	760-742-9919
Fax Number	:	760-741-2782

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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