MEDICARE: TU TRAM HUYNH NGUYEN MSW

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	104100000X	Social Worker	97109	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1205316403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TU TRAM HUYNH NGUYEN MSW

Provider Business Mailing Address
First Line	:	1902 MARENGO ST STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1378
Country	:	US
Telephone Number	:	626-689-9864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 MARENGO ST STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1378
Country	:	US
Telephone Number	:	323-276-6490
Fax Number	:

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

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	10/20/2020

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