MEDICARE: AN LIEN PHUONG 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	183500000X	Pharmacist	59022	CA

General Provider Information

NPI Number	:	1205136702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AN LIEN PHUONG NGUYEN

Provider Business Mailing Address
First Line	:	850 WOODSIDE RD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 WOODSIDE RD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3746
Country	:	US
Telephone Number	:	650-365-3682
Fax Number	:

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

Provider Enumeration Date	:	10/30/2010
Last Update Date	:	10/30/2010

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Directions to “ AN LIEN PHUONG NGUYEN ” Practice Location

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