MEDICARE: DR. JACQUELYN YEN 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	207R00000X	Internal Medicine Physician	A102714	CA

General Provider Information

NPI Number	:	1982855417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELYN YEN NGUYEN M.D.

Provider Business Mailing Address
First Line	:	2901 S SEPULVEDA BLVD APT 159
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3941
Country	:	US
Telephone Number	:	714-307-5029
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 S SEPULVEDA BLVD APT 159
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3941
Country	:	US
Telephone Number	:	714-307-5029
Fax Number	:

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	12/02/2021

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