MEDICARE: DEREK NGUYEN MD INC

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	207R00000X	Internal Medicine Physician	A87744	CA

General Provider Information

NPI Number	:	1700184280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREK NGUYEN MD INC

Provider Business Mailing Address
First Line	:	4435 BROCKTON AVE STE B
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-4004
Country	:	US
Telephone Number	:	951-683-6830
Fax Number	:	951-228-9458

Provider Business Practice Location Address
First Line	:	4435 BROCKTON AVE STE B
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-4004
Country	:	US
Telephone Number	:	951-683-6830
Fax Number	:	951-228-9458

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK HOA THANH NGUYEN
Credential	:	MD
Telephone Number	:	951-683-6830

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	09/07/2022

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