MEDICARE: DAVE PHAT 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	247200000X	Other Technician

General Provider Information

NPI Number	:	1992829907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVE PHAT NGUYEN

Provider Business Mailing Address
First Line	:	1968 W ADAMS BLVD # 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3515
Country	:	US
Telephone Number	:	323-731-3534
Fax Number	:	323-731-5618

Provider Business Practice Location Address
First Line	:	1968 W ADAMS BLVD # 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3515
Country	:	US
Telephone Number	:	323-731-3534
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/17/2025

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Directions to “ DAVE PHAT NGUYEN ” Practice Location

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