MEDICARE: VY NGUYEN

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1174156475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VY NGUYEN

Provider Business Mailing Address
First Line	:	9126 VALLEY BLVD STE B
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-1987
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9126 VALLEY BLVD STE B
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-1987
Country	:	US
Telephone Number	:	818-913-4134
Fax Number	:

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

Provider Enumeration Date	:	02/15/2020
Last Update Date	:	02/15/2020

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Directions to “ VY NGUYEN ” Practice Location

Language	Start Address	Practice Location

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