MEDICARE: TIEP KIM NGUYEN MD 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1215091434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIEP KIM NGUYEN MD INC

Provider Business Mailing Address
First Line	:	12650 SHERMAN WAY
Second Line	:	SUITE3
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605
Country	:	US
Telephone Number	:	818-764-5775
Fax Number	:	818-764-6273

Provider Business Practice Location Address
First Line	:	12650 SHERMAN WAY
Second Line	:	SUITE 3
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5232
Country	:	US
Telephone Number	:	818-764-5775
Fax Number	:	818-764-6273

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. TIEP KIM NGUYEN
Credential	:	M.D
Telephone Number	:	818-764-5775

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	02/26/2011

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