MEDICARE: DR. AUDREY HONG NGHIEM

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	6561	NV
2	1223G0001X	General Practice Dentistry	25566	TX
3	1223P0221X	Pediatric Dentistry	S6-186	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S6-186	OTHER	NV	NEVADA LICENSE
2	6561	OTHER	NV	NEVADA LICENSE

General Provider Information

NPI Number	:	1700190790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY HONG NGHIEM

Provider Business Mailing Address
First Line	:	3220 S DURANGO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 S DURANGO DR STE B2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4410
Country	:	US
Telephone Number	:	817-821-7696
Fax Number	:

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

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	05/29/2023

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