MEDICARE: MADELEINE NGUYEN NGO M.D.

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	208000000X	Pediatrics Physician	A34849	CA
2	2080A0000X	Pediatric Adolescent Medicine Physician	A34849	CA

General Provider Information

NPI Number	:	1295911915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE NGUYEN NGO M.D.

Provider Business Mailing Address
First Line	:	2236 JESLEW CT
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-6840
Country	:	US
Telephone Number	:	626-965-4871
Fax Number	:

Provider Business Practice Location Address
First Line	:	2236 JESLEW CT
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-6840
Country	:	US
Telephone Number	:	626-965-4871
Fax Number	:

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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