MEDICARE: DR. TRAIHOA THI 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	208000000X	Pediatrics Physician	A40243	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ47768Z	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1164475307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAIHOA THI NGUYEN M.D

Provider Business Mailing Address
First Line	:	1450 TREAT BLVD STE 160
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:	925-296-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 GLEN COVE MARINA RD E
Second Line	:	SUITE 100
City	:	VALLEJO
State	:	CA
Zip	:	94591-7284
Country	:	US
Telephone Number	:	707-558-8699
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/17/2018

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