MEDICARE: MATTHEW NGUYEN

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	1223P0221X	Pediatric Dentistry	DDS107114	CA

General Provider Information

NPI Number	:	1629693262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW NGUYEN

Provider Business Mailing Address
First Line	:	1417 S WESTGATE AVE PH 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 S WESTGATE AVE PH 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5277
Country	:	US
Telephone Number	:	818-857-1154
Fax Number	:

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

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	07/01/2025

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Directions to “ MATTHEW NGUYEN ” Practice Location

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