MEDICARE: DR. THU XUAN 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	42940	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B42940	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1043222110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THU XUAN NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	647 S BERNARDO AVE
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1020
Country	:	US
Telephone Number	:	408-735-7535
Fax Number	:	408-735-7536

Provider Business Practice Location Address
First Line	:	647 S BERNARDO AVE
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1020
Country	:	US
Telephone Number	:	408-735-7535
Fax Number	:	408-735-7536

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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