MEDICARE: DR. TUAN DUC NGUYEN D.C

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	111N00000X	Chiropractor	22941	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC22941	OTHER	CA	CALOPTIMA, BLUESHIELD

General Provider Information

NPI Number	:	1326119090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUAN DUC NGUYEN D.C

Provider Business Mailing Address
First Line	:	PO BOX 280
Second Line	:
City	:	ATWOOD
State	:	CA
Zip	:	92811-0280
Country	:	US
Telephone Number	:	714-554-5304
Fax Number	:	714-554-6052

Provider Business Practice Location Address
First Line	:	10666 CHAPMAN AVE # 3
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3103
Country	:	US
Telephone Number	:	714-554-5304
Fax Number	:	714-554-6052

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/16/2016

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