MEDICARE: GRACE NAM HUGHES D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	64539	CA

General Provider Information

NPI Number	:	1326424136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE NAM HUGHES D.D.S.

Provider Business Mailing Address
First Line	:	4764 FIR AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-3011
Country	:	US
Telephone Number	:	832-305-6063
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1424
Country	:	US
Telephone Number	:	562-421-9439
Fax Number	:

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/31/2022

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