MEDICARE: ANNIE BANG ANH NGUYEN M.ED

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	103K00000X	Behavior Analyst	1-19-35665	CA

General Provider Information

NPI Number	:	1467911362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE BANG ANH NGUYEN M.ED

Provider Business Mailing Address
First Line	:	1407 N BATAVIA ST STE 219
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-3525
Country	:	US
Telephone Number	:	657-456-8558
Fax Number	:	833-256-3911

Provider Business Practice Location Address
First Line	:	1407 N BATAVIA ST STE 219
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-3525
Country	:	US
Telephone Number	:	657-456-8558
Fax Number	:	833-256-3911

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	08/07/2019

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