MEDICARE: JOSEPHINE BA 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	207VG0400X	Gynecology Physician	A157172	CA
2	207VG0400X	Gynecology Physician	036178663	IL

General Provider Information

NPI Number	:	1487185583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE BA NGUYEN M.D.

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-3175
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	133 E BRUSH HILL RD STE 308
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-5662
Country	:	US
Telephone Number	:	331-221-9006
Fax Number	:	331-221-2734

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/09/2026

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