MEDICARE: KATHY MY NGUYEN CHIROPRACTIC

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	DC30725	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BI896A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1750652467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHY MY NGUYEN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3005 SILVER CREEK RD
Second Line	:	154
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1789
Country	:	US
Telephone Number	:	408-270-3622
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 SILVER CREEK RD
Second Line	:	154
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1789
Country	:	US
Telephone Number	:	408-270-3622
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHY NGUYEN
Credential	:	D.C
Telephone Number	:	408-270-3622

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	01/26/2012

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