MEDICARE: MISS HONG DIEM NGUYEN PA-C

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	363AM0700X	Medical Physician Assistant	PA00718	OR

General Provider Information

NPI Number	:	1508849324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HONG DIEM NGUYEN PA-C

Provider Business Mailing Address
First Line	:	9735 SW SHADY LN
Second Line	:	#102
City	:	TIGARD
State	:	OR
Zip	:	97223-5481
Country	:	US
Telephone Number	:	503-620-5614
Fax Number	:	503-598-4688

Provider Business Practice Location Address
First Line	:	9735 SW SHADY LN
Second Line	:	#102
City	:	TIGARD
State	:	OR
Zip	:	97223-5481
Country	:	US
Telephone Number	:	503-620-5614
Fax Number	:	503-598-4688

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	08/12/2008

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Directions to “ MISS HONG DIEM NGUYEN PA-C” Practice Location

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