MEDICARE: GARDEN GROVE WOMEN'S HEALTH SPECIALISTS, 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	207V00000X	Obstetrics & Gynecology Physician	20A7161	CA

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	:	1396960563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN GROVE WOMEN'S HEALTH SPECIALISTS, INC.

Provider Business Mailing Address
First Line	:	12555 GARDEN GROVE BLVD STE 301
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1903
Country	:	US
Telephone Number	:	714-741-0501
Fax Number	:	714-741-0095

Provider Business Practice Location Address
First Line	:	12555 GARDEN GROVE BLVD STE 301
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1903
Country	:	US
Telephone Number	:	714-741-0501
Fax Number	:	714-741-0095

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHU NGUYEN
Credential	:	D.O.
Telephone Number	:	714-741-0501

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	10/02/2014

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