MEDICARE: SONG HA NGUYEN

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	7598	NV

General Provider Information

NPI Number	:	1275201188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONG HA NGUYEN

Provider Business Mailing Address
First Line	:	12013 GIRASOLE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-4657
Country	:	US
Telephone Number	:	678-862-2320
Fax Number	:

Provider Business Practice Location Address
First Line	:	4080 N MLK BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3216
Country	:	US
Telephone Number	:	702-903-2127
Fax Number	:

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

Provider Enumeration Date	:	09/03/2021
Last Update Date	:	07/23/2025

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Directions to “ SONG HA NGUYEN ” Practice Location

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