MEDICARE: ANTHONY D. NGUYEN, DDS, INC

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	305R00000X	Preferred Provider Organization	47971	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104023647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY D. NGUYEN, DDS, INC

Provider Business Mailing Address
First Line	:	1290 N GAREY AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3806
Country	:	US
Telephone Number	:	909-623-1564
Fax Number	:	909-629-9126

Provider Business Practice Location Address
First Line	:	1290 N GAREY AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3806
Country	:	US
Telephone Number	:	909-623-1564
Fax Number	:	909-629-9126

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY DUNG NGUYEN
Credential	:	DDS
Telephone Number	:	909-623-1564

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	11/13/2007

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