MEDICARE: KHANH NGUYEN DDS

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	122300000X	Dentist	40969	CA

General Provider Information

NPI Number	:	1073904744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANH NGUYEN DDS

Provider Business Mailing Address
First Line	:	2567 W LAKE VAN NESS CIR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-7023
Country	:	US
Telephone Number	:	559-273-3375
Fax Number	:	559-251-7190

Provider Business Practice Location Address
First Line	:	2567 W LAKE VAN NESS CIR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-7023
Country	:	US
Telephone Number	:	559-273-3375
Fax Number	:	559-251-7190

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	02/16/2015

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Directions to “ KHANH NGUYEN DDS” Practice Location

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