MEDICARE: QUON 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	40476	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275690810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUON NGUYEN DDS

Provider Business Mailing Address
First Line	:	2887 SENTER RD
Second Line	:	SUITE # 106
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1180
Country	:	US
Telephone Number	:	408-224-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2887 SENTER RD
Second Line	:	SUITE # 106
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1180
Country	:	US
Telephone Number	:	408-224-6222
Fax Number	:	408-224-6266

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/09/2007

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Directions to “ QUON NGUYEN DDS” Practice Location

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