MEDICARE: KATHERINE 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	207R00000X	Internal Medicine Physician	20A21616	CA

General Provider Information

NPI Number	:	1871235556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE NGUYEN

Provider Business Mailing Address
First Line	:	22110 ROSCOE BLVD STE 100
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22110 ROSCOE BLVD STE 100
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3875
Country	:	US
Telephone Number	:	818-481-0118
Fax Number	:

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

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	06/19/2025

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