MEDICARE: DR PAULINE 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	122300000X	Dentist	49954	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	:	1467433276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR PAULINE NGUYEN DDS INC

Provider Business Mailing Address
First Line	:	6039 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2304
Country	:	US
Telephone Number	:	714-994-1456
Fax Number	:	714-994-1530

Provider Business Practice Location Address
First Line	:	6039 BEACH BLVD
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2304
Country	:	US
Telephone Number	:	714-994-1456
Fax Number	:	714-994-1530

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	PAULINE NGUYEN
Credential	:	DDS
Telephone Number	:	714-994-1456

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/22/2020

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