MEDICARE: DR. TUYET-BINH NGUYEN D.D.S.

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	1223G0001X	General Practice Dentistry	36403	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36403	OTHER	CA	DENTIST LICENSE
2	B3640301	OTHER	CA	DENTICAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1881790152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUYET-BINH NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	5210 W. FIRST STREET
Second Line	:	SUITE F
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3000
Country	:	US
Telephone Number	:	714-554-6878
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 W. FIRST STREET
Second Line	:	SUITE F
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3000
Country	:	US
Telephone Number	:	714-554-6878
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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