MEDICARE: LINH 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	1223G0001X	General Practice Dentistry	61482212	WA

General Provider Information

NPI Number	:	1093595977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINH NGUYEN

Provider Business Mailing Address
First Line	:	12412 LAKE CITY BLVD SW
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98498-4206
Country	:	US
Telephone Number	:	703-628-4775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 SW SCOTTON WAY
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-2715
Country	:	US
Telephone Number	:	360-843-2001
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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Directions to “ LINH NGUYEN ” Practice Location

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