MEDICARE: MANH HUNG JORDAN NGUYEN PA-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	363A00000X	Physician Assistant	PA.0007502	CO

General Provider Information

NPI Number	:	1780313833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANH HUNG JORDAN NGUYEN PA-C

Provider Business Mailing Address
First Line	:	21030 E STANFORD PL
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-5563
Country	:	US
Telephone Number	:	727-254-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	10120 TWENTY MILE RD
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-5666
Country	:	US
Telephone Number	:	727-254-0447
Fax Number	:

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

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	04/06/2023

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