=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891957395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOP TRUNG NGUYEN, D.D.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2008
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6464 W SUNSET BLVD 1020
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-469-1665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6464 W SUNSET BLVD 1020
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-469-1665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HOP TRUNG NGUYEN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 323-469-1665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DM34390
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------