MEDICARE: THAI CURTIS NGUYEN-CLEARY MD

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	A86079	CA

General Provider Information

NPI Number	:	1467442624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAI CURTIS NGUYEN-CLEARY MD

Provider Business Mailing Address
First Line	:	1001 N MARTEL AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6611
Country	:	US
Telephone Number	:	323-436-5019
Fax Number	:	323-436-5034

Provider Business Practice Location Address
First Line	:	1300 N VERMONT AVE
Second Line	:	SUITE 407
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6005
Country	:	US
Telephone Number	:	323-662-0492
Fax Number	:	323-662-0196

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	04/23/2024

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