MEDICARE: MIRNA NGUYEN DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	60757	CA

General Provider Information

NPI Number	:	1316275407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRNA NGUYEN DMD

Provider Business Mailing Address
First Line	:	3202 GOVERNOR DR
Second Line	:	SUITE 207
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2938
Country	:	US
Telephone Number	:	858-450-1334
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 GOVERNOR DR
Second Line	:	SUITE 207
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2938
Country	:	US
Telephone Number	:	858-450-1334
Fax Number	:

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

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	05/25/2016

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Directions to “ MIRNA NGUYEN DMD” Practice Location

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