MEDICARE: LINH NGUYEN DDS

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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1033109996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINH NGUYEN DDS

Provider Business Mailing Address
First Line	:	5129 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3012
Country	:	US
Telephone Number	:	773-275-8083
Fax Number	:	773-275-9224

Provider Business Practice Location Address
First Line	:	5129 N BROADWAY ST
Second Line	:	E
City	:	CHICAGO
State	:	IL
Zip	:	60640-3018
Country	:	US
Telephone Number	:	773-275-8083
Fax Number	:	773-275-9224

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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Directions to “ LINH NGUYEN DDS” Practice Location

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