MEDICARE: MIMI NGUYEN LCSW

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	1041C0700X	Clinical Social Worker	29176	CA

General Provider Information

NPI Number	:	1851415483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIMI NGUYEN LCSW

Provider Business Mailing Address
First Line	:	1968 W ADAMS BLVD STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3515
Country	:	US
Telephone Number	:	323-731-3534
Fax Number	:	323-731-3534

Provider Business Practice Location Address
First Line	:	1968 W ADAMS BLVD STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3515
Country	:	US
Telephone Number	:	323-731-3534
Fax Number	:	323-731-5618

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	03/10/2021

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Directions to “ MIMI NGUYEN LCSW” Practice Location

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