MEDICARE: MR. NAM VAN 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	122300000X	Dentist	12681	TX

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	:	1558425256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NAM VAN NGUYEN DDS

Provider Business Mailing Address
First Line	:	2808 MILAM ST
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77006-3599
Country	:	US
Telephone Number	:	713-520-7950
Fax Number	:	713-900-4067

Provider Business Practice Location Address
First Line	:	3310 TRAVIS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006
Country	:	US
Telephone Number	:	713-520-7950
Fax Number	:	713-520-0610

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	03/01/2016

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