MEDICARE: TRUC THANH 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	1223G0001X	General Practice Dentistry	43214	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43214	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1285653758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUC THANH NGUYEN DDS

Provider Business Mailing Address
First Line	:	32700 ALVARADO BLVD
Second Line	:	15931 HESPERIAN BLVD SAN LORENZO, CA 94580
City	:	FREMONT
State	:	CA
Zip	:	94555-1202
Country	:	US
Telephone Number	:	510-477-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	32700 ALVARADO BLVD
Second Line	:	15931 HESPERIAN BLVD SAN LORENZO, CA 94580
City	:	FREMONT
State	:	CA
Zip	:	94555-1202
Country	:	US
Telephone Number	:	510-477-0811
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/25/2007

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