MEDICARE: TIENG KIM 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	39458	CA

General Provider Information

NPI Number	:	1790836435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIENG KIM NGUYEN DDS

Provider Business Mailing Address
First Line	:	8891 WESTMINSTER AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-2608
Country	:	US
Telephone Number	:	714-897-2716
Fax Number	:	714-895-7356

Provider Business Practice Location Address
First Line	:	8891 WESTMINSTER AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-2608
Country	:	US
Telephone Number	:	714-897-2716
Fax Number	:	714-895-7356

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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