MEDICARE: DR. XUAN NGUYET NGUYEN M.D.

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	207Q00000X	Family Medicine Physician	A88148	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871539551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XUAN NGUYET NGUYEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 12089
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92423-2089
Country	:	US
Telephone Number	:	909-793-3311
Fax Number	:	909-796-4158

Provider Business Practice Location Address
First Line	:	10431 LEMON AVE
Second Line	:	UNIT N
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3700
Country	:	US
Telephone Number	:	909-466-6579
Fax Number	:	909-796-4158

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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