MEDICARE: JENNIFER T. NGUYEN, DMD, INC.

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

General Provider Information

NPI Number	:	1417428376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER T. NGUYEN, DMD, INC.

Provider Business Mailing Address
First Line	:	888 S FIGUEROA ST STE 750
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2776
Country	:	US
Telephone Number	:	213-340-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 S FIGUEROA ST STE 750
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2776
Country	:	US
Telephone Number	:	213-340-3355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JENNIFER NGUYEN
Credential	:	DMD
Telephone Number	:	213-340-3355

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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