MEDICARE: THOMAS NGUYEN DENTAL CORP

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	46305	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G92287-02	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1043435365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS NGUYEN DENTAL CORP

Provider Business Mailing Address
First Line	:	11408 WASHINGTON BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-3122
Country	:	US
Telephone Number	:	562-463-1111
Fax Number	:	562-463-8994

Provider Business Practice Location Address
First Line	:	11408 E WASHINGTON BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-3122
Country	:	US
Telephone Number	:	562-463-1111
Fax Number	:	562-463-8994

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. PETER T NGUYEN
Credential	:	D.D.S.
Telephone Number	:	562-463-1111

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/22/2020

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