MEDICARE: HUNG KHAI NGUYEN,D.D.S. ,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	122300000X	Dentist	38722	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	:	1104230747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNG KHAI NGUYEN,D.D.S. ,INC

Provider Business Mailing Address
First Line	:	4712 EL CAJON BLVD STE G
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4557
Country	:	US
Telephone Number	:	619-521-0580
Fax Number	:	619-640-0640

Provider Business Practice Location Address
First Line	:	4712 EL CAJON BLVD STE G
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4557
Country	:	US
Telephone Number	:	619-521-0580
Fax Number	:	619-640-0640

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HUNG KHAI NGUYEN
Credential	:	DDS
Telephone Number	:	619-521-0580

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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