MEDICARE: MS. PHUONG GIA HOANG 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861566796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHUONG GIA HOANG NGUYEN

Provider Business Mailing Address
First Line	:	2437 EPSTEIN CT
Second Line	:
City	:	BROOKEVILLE
State	:	MD
Zip	:	20833-3280
Country	:	US
Telephone Number	:	646-422-9958
Fax Number	:

Provider Business Practice Location Address
First Line	:	2437 EPSTEIN CT
Second Line	:
City	:	BROOKEVILLE
State	:	MD
Zip	:	20833-3280
Country	:	US
Telephone Number	:	646-422-9958
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	06/29/2023

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