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NPI Code Detail

MEDICARE: JOHN NGOC NGUYEN

MEDICARE: JOHN NGOC NGUYEN
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1770120578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN NGOC NGUYEN
Provider Business Mailing Address
First Line : 9501 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-4711
Country : US
Telephone Number : 216-368-0575
Fax Number :
Provider Business Practice Location Address
First Line : 9501 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-4711
Country : US
Telephone Number : 216-368-0575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2019
Last Update Date : 01/07/2022

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Directions to “ JOHN NGOC NGUYEN ” Practice Location

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