MEDICARE: MICHAEL N NGUYEN DMD

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	DDS102643	CA

General Provider Information

NPI Number	:	1588139752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL N NGUYEN DMD

Provider Business Mailing Address
First Line	:	2632 CARLO SCIMECA CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2607
Country	:	US
Telephone Number	:	408-859-5574
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 GRAVES AVE STE 11A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-5014
Country	:	US
Telephone Number	:	408-753-9955
Fax Number	:

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

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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