=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609847151
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMKHOI THI NGUYEN D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2006
-----------------------------------------------------
Last Update Date | 06/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9376 WESTMINSTER BLVD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-895-4255
-----------------------------------------------------
Fax | 714-898-8294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9376 WESTMINSTER BLVD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-895-4255
-----------------------------------------------------
Fax | 714-898-8294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 33346
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------