MEDICARE: SHEENA NGUYEN D.O.

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	207N00000X	Dermatology Physician	20A14301	CA
2	207R00000X	Internal Medicine Physician	UO3992	FL
3	207N00000X	Dermatology Physician	OP60852010	WA

General Provider Information

NPI Number	:	1356753743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEENA NGUYEN D.O.

Provider Business Mailing Address
First Line	:	1793 13TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2541
Country	:	US
Telephone Number	:	503-362-8385
Fax Number	:	503-362-8435

Provider Business Practice Location Address
First Line	:	21727 76TH AVE W STE H
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	425-672-1333
Fax Number	:	206-525-1169

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

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	10/10/2024

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