MEDICARE: DA-HUONG NGUYEN, 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	1223G0001X	General Practice Dentistry	50168	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912961863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DA-HUONG NGUYEN, DDS, INC

Provider Business Mailing Address
First Line	:	1692 TULLY RD
Second Line	:	18
City	:	SAN JOSE
State	:	CA
Zip	:	95122-2549
Country	:	US
Telephone Number	:	408-270-2777
Fax Number	:	408-270-6777

Provider Business Practice Location Address
First Line	:	1692 TULLY RD
Second Line	:	18
City	:	SAN JOSE
State	:	CA
Zip	:	95122-2549
Country	:	US
Telephone Number	:	408-270-2777
Fax Number	:	408-270-6777

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DA-HUONG THI NGUYEN
Credential	:	D.D.S.
Telephone Number	:	408-270-2777

Provider Enumeration Date	:	04/15/2006
Last Update Date	:	08/22/2020

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