MEDICARE: DR. KHAI QUANG TRAN 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	38569	CA

General Provider Information

NPI Number	:	1215129424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHAI QUANG TRAN NGUYEN DDS

Provider Business Mailing Address
First Line	:	1644 B ST
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94541-3020
Country	:	US
Telephone Number	:	510-538-9701
Fax Number	:	510-538-5217

Provider Business Practice Location Address
First Line	:	1644 B ST
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94541-3020
Country	:	US
Telephone Number	:	510-538-9701
Fax Number	:	510-538-5217

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

Provider Enumeration Date	:	08/11/2007
Last Update Date	:	08/11/2007

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