MEDICARE: DR. HUNG KHAI 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	38722	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306976121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUNG KHAI NGUYEN DDS

Provider Business Mailing Address
First Line	:	4712 EL CAJON BLVD STE G
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4557
Country	:	US
Telephone Number	:	619-521-0580
Fax Number	:	619-640-0640

Provider Business Practice Location Address
First Line	:	4712 EL CAJON BLVD
Second Line	:	#G
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4557
Country	:	US
Telephone Number	:	619-521-0580
Fax Number	:	619-640-0640

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	05/28/2008

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