MEDICARE: DR. VAN B NGUYEN M.D.

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	207Q00000X	Family Medicine Physician	G069891	CA

General Provider Information

NPI Number	:	1447330402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAN B NGUYEN M.D.

Provider Business Mailing Address
First Line	:	6000 N FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4232
Country	:	US
Telephone Number	:	323-254-5291
Fax Number	:	323-254-4618

Provider Business Practice Location Address
First Line	:	4837 HUNTINGTON DR N STE 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1953
Country	:	US
Telephone Number	:	323-225-0024
Fax Number	:	323-225-0023

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/11/2012

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