MEDICARE: JONATHAN ANH TUAN MANH

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1881470003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ANH TUAN MANH

Provider Business Mailing Address
First Line	:	18945 EVENING BREEZE CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6723
Country	:	US
Telephone Number	:	714-944-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	18945 EVENING BREEZE CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6723
Country	:	US
Telephone Number	:	714-944-9645
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/04/2023

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