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NPI Code Detail

MEDICARE: DR. TIFFANY NGUYEN DDS, MS

MEDICARE: DR. TIFFANY NGUYEN DDS, MS
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
1122300000XDentist63795CA
21223G0001XGeneral Practice Dentistry63795CA

General Provider Information

NPI Number : 1467861732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIFFANY NGUYEN DDS, MS
Provider Business Mailing Address
First Line : 1738 AVIATION BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90278-2810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1738 AVIATION BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90278-2810
Country : US
Telephone Number : 310-372-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2014
Last Update Date : 08/12/2014

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