MEDICARE: DR. KHANH QUOC NGUYEN D.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	111N00000X	Chiropractor	DC19931	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730261231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHANH QUOC NGUYEN D.C.

Provider Business Mailing Address
First Line	:	1370 TULLY RD
Second Line	:	SUITE 508
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3056
Country	:	US
Telephone Number	:	408-298-4560
Fax Number	:	408-516-5262

Provider Business Practice Location Address
First Line	:	1370 TULLY RD
Second Line	:	SUITE 508
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3056
Country	:	US
Telephone Number	:	408-298-4560
Fax Number	:	408-516-5262

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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