MEDICARE: VAN NGUYEN LLC PAC

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	:	1235091679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN NGUYEN LLC PAC

Provider Business Mailing Address
First Line	:	10327 DALLINGTON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-9032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10327 DALLINGTON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-9032
Country	:	US
Telephone Number	:	714-360-9165
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VAN NGUYEN
Credential	:	PA-C
Telephone Number	:	714-360-9165

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	12/15/2025

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