MEDICARE: CAMTAM 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	122300000X	Dentist	47648	CA

General Provider Information

NPI Number	:	1154523603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMTAM NGUYEN DDS INC

Provider Business Mailing Address
First Line	:	1057 E CAPITOL EXPWY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-2415
Country	:	US
Telephone Number	:	408-972-2911
Fax Number	:	408-972-1881

Provider Business Practice Location Address
First Line	:	1057 E CAPITOL EXPWY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-2415
Country	:	US
Telephone Number	:	408-972-2911
Fax Number	:	408-972-2911

Authorized Official
Title or Position	:	OWNER
Name	:	CAMTAM TONG NGUYEN
Credential	:	DDS
Telephone Number	:	408-972-2911

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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