MEDICARE: KHANH-UYEN TINA HUU NGUYEN PA

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	363AM0700X	Medical Physician Assistant	PA189616	OR
2	363AM0700X	Medical Physician Assistant	PA19500	TX
3	207Q00000X	Family Medicine Physician	PA60963344	WA

General Provider Information

NPI Number	:	1396397261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANH-UYEN TINA HUU NGUYEN PA

Provider Business Mailing Address
First Line	:	1825 MAPLE ST
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1939
Country	:	US
Telephone Number	:	503-359-6180
Fax Number	:	503-359-6105

Provider Business Practice Location Address
First Line	:	1825 MAPLE ST
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1939
Country	:	US
Telephone Number	:	503-359-6180
Fax Number	:	503-359-6105

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

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	12/03/2025

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Directions to “ KHANH-UYEN TINA HUU NGUYEN PA” Practice Location

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