MEDICARE: LINDA 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	41971	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9136401	OTHER	CA	DENTICAL PROVIDER NUMBER
2	D41971	OTHER	CA	RENDERING PROVIDER NUMBER

General Provider Information

NPI Number	:	1356494082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA NGUYEN DDS

Provider Business Mailing Address
First Line	:	4106 SAN FERNANDO RD STE D
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-3821
Country	:	US
Telephone Number	:	818-549-2227
Fax Number	:	818-549-2228

Provider Business Practice Location Address
First Line	:	4106 SAN FERNANDO RD STE D
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-3821
Country	:	US
Telephone Number	:	323-804-4098
Fax Number	:	818-549-2227

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/22/2020

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