MEDICARE: ANH TAI NGUYEN 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	176263-1205	UT

General Provider Information

NPI Number	:	1699764407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANH TAI NGUYEN MD

Provider Business Mailing Address
First Line	:	1819 W 3500 S
Second Line	:	SUITE 1C
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3457
Country	:	US
Telephone Number	:	801-975-9707
Fax Number	:	801-975-9373

Provider Business Practice Location Address
First Line	:	1819 W 3500 S
Second Line	:	SUITE 1C
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3457
Country	:	US
Telephone Number	:	801-975-9707
Fax Number	:	801-975-9373

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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