MEDICARE: DR. TAM THI NGUYEN D.D.S.

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	1223G0001X	General Practice Dentistry	41200	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B41200-02	OTHER	CA	DENTI-CAL
2	902884	OTHER	CA	UNITED CONCORDIA INS.

General Provider Information

NPI Number	:	1265576896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAM THI NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	5544 MONTEREY HWY.
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1529
Country	:	US
Telephone Number	:	408-362-9767
Fax Number	:	408-362-9700

Provider Business Practice Location Address
First Line	:	5544 MONTEREY HWY.
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1529
Country	:	US
Telephone Number	:	408-362-9767
Fax Number	:	408-362-9700

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	04/20/2023

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