MEDICARE: TUAN NGUYEN, M.D., INC

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	207RG0100X	Gastroenterology Physician	G68761	CA

General Provider Information

NPI Number	:	1154569986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUAN NGUYEN, M.D., INC

Provider Business Mailing Address
First Line	:	PO BOX 420988
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92142-0988
Country	:	US
Telephone Number	:	619-563-4040
Fax Number	:	619-563-1204

Provider Business Practice Location Address
First Line	:	4141 FAIRMOUNT AVE
Second Line	:	SUITE #201
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1609
Country	:	US
Telephone Number	:	619-563-4040
Fax Number	:	619-563-1204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TUAN NGUYEN
Credential	:	MD
Telephone Number	:	619-563-4040

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/02/2009

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