MEDICARE: HUNG K. DO, DDS, INC.

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	1223E0200X	Endodontics	45681	CA
2	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1740343730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNG K. DO, DDS, INC.

Provider Business Mailing Address
First Line	:	9561 LAGUNA SPRINGS DR., STE. 100
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758
Country	:	US
Telephone Number	:	916-683-4255
Fax Number	:	916-683-4256

Provider Business Practice Location Address
First Line	:	9561 LAGUNA SPRINGS DR., STE. 100
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758
Country	:	US
Telephone Number	:	916-683-4255
Fax Number	:	916-683-4256

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. HUNG K. DO
Credential	:	D.D.S.
Telephone Number	:	916-683-4255

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/17/2014

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