MEDICARE: HUONG THI LE NGUYEN MD

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	207Q00000X	Family Medicine Physician	A34653	CA
2	208000000X	Pediatrics Physician	A34653	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265506794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUONG THI LE NGUYEN MD

Provider Business Mailing Address
First Line	:	4444 EL CAJON BLVD
Second Line	:	SUITE #6
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4312
Country	:	US
Telephone Number	:	619-285-1522
Fax Number	:	619-285-0714

Provider Business Practice Location Address
First Line	:	4444 EL CAJON BLVD
Second Line	:	SUITE #6
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4312
Country	:	US
Telephone Number	:	619-285-1522
Fax Number	:	619-285-0714

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	10/22/2014

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