MEDICARE: SAN DIEGORHEUMATOLOGY MEDICAL GROUP, 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	174400000X	Specialist

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	:	1356319099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGORHEUMATOLOGY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	202 LEWIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2107
Country	:	US
Telephone Number	:	619-293-0351
Fax Number	:	619-293-0352

Provider Business Practice Location Address
First Line	:	202 LEWIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2107
Country	:	US
Telephone Number	:	619-293-0351
Fax Number	:	619-293-0352

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHERINE H.Y. NGUYEN
Credential	:	M.D.
Telephone Number	:	619-293-0351

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/22/2020

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