MEDICARE: KIMBERLY TRAN-NGUYEN DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DN22835	FL

General Provider Information

NPI Number	:	1245764968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY TRAN-NGUYEN DMD

Provider Business Mailing Address
First Line	:	5805 TRACE MEADOW LOOP APT 303
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-2636
Country	:	US
Telephone Number	:	305-801-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	6421 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3102
Country	:	US
Telephone Number	:	813-888-9004
Fax Number	:

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

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	06/09/2021

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