MEDICARE: NEWGEN AESTHETICS & WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WH0200X	Home Health Registered Nurse
2	225100000X	Physical Therapist
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417623380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWGEN AESTHETICS & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 217954
Second Line	:
City	:	BARRIGADA
State	:	GU
Zip	:	96921-6957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	643 CHALAN SAN ANTONIO STE 108
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913-3644
Country	:	US
Telephone Number	:	671-735-8000
Fax Number	:	671-735-8003

Authorized Official
Title or Position	:	CEO
Name	:	LUAN NGUYEN
Credential	:	MD
Telephone Number	:	671-735-8000

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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