MEDICARE: AN NGUYEN DDS, INC

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	DDS101989	CA

General Provider Information

NPI Number	:	1184126781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN NGUYEN DDS, INC

Provider Business Mailing Address
First Line	:	14341 BEACH BLVD STE I
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4561
Country	:	US
Telephone Number	:	714-839-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	14341 BEACH BLVD STE I
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4561
Country	:	US
Telephone Number	:	714-839-0793
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AN NGUYEN
Credential	:	DDS
Telephone Number	:	949-545-4753

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	03/17/2018

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