MEDICARE: KHANH DUY 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	19859	TX

General Provider Information

NPI Number	:	1285786723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANH DUY NGUYEN DDS

Provider Business Mailing Address
First Line	:	12804 GULF FWY
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77034-4813
Country	:	US
Telephone Number	:	281-481-2048
Fax Number	:	281-484-4193

Provider Business Practice Location Address
First Line	:	12804 GULF FWY
Second Line	:	SUITE 400
City	:	HOUSTON
State	:	TX
Zip	:	77034-4813
Country	:	US
Telephone Number	:	281-481-2048
Fax Number	:	281-484-4193

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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