MEDICARE: THAI NGUYEN FNP-C

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	363L00000X	Nurse Practitioner	F09201678	CA

General Provider Information

NPI Number	:	1982206876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAI NGUYEN FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 10776
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92423-0776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13850 CITY CENTER DR STE 5045
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5416
Country	:	US
Telephone Number	:	909-645-0429
Fax Number	:

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

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	11/15/2020

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