MEDICARE: CENTRAL VALLEY MEDICAL CLINIC, 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	2085R0202X	Diagnostic Radiology Physician	A42303	CA
2	2085U0001X	Diagnostic Ultrasound Physician	A42303	CA
3	208D00000X	General Practice Physician	A42303	CA

General Provider Information

NPI Number	:	1831462092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VALLEY MEDICAL CLINIC, INC

Provider Business Mailing Address
First Line	:	7227 RESEDA BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-708-7227
Fax Number	:	818-708-3740

Provider Business Practice Location Address
First Line	:	7227 RESEDA BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3046
Country	:	US
Telephone Number	:	818-708-7227
Fax Number	:	818-708-3740

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. HUNG VAN NGUYEN
Credential	:	M.D.
Telephone Number	:	818-708-7227

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	02/20/2012

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