MEDICARE: HIENTHU T DO D.D.S

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	43938	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B43938-01	OTHER	CA	DENTI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1396957494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIENTHU T DO D.D.S

Provider Business Mailing Address
First Line	:	7440 EL MORRO WAY
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2607
Country	:	US
Telephone Number	:	323-266-2120
Fax Number	:	323-266-7297

Provider Business Practice Location Address
First Line	:	2319 S ATLANTIC BLVD
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-1201
Country	:	US
Telephone Number	:	323-266-2120
Fax Number	:	323-266-7297

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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Directions to “ HIENTHU T DO D.D.S” Practice Location

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