MEDICARE: DR. ERIQ F 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	122300000X	Dentist	57276	CA

General Provider Information

NPI Number	:	1336304955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIQ F NGUYEN DDS

Provider Business Mailing Address
First Line	:	33 CREEK RD STE 350
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7708
Country	:	US
Telephone Number	:	949-936-0022
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 CREEK RD STE 350
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7708
Country	:	US
Telephone Number	:	949-936-0022
Fax Number	:

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

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	07/20/2020

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