MEDICARE: DR. KHANG T. NGUYEN D.M.D.

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	036589	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447369301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHANG T. NGUYEN D.M.D.

Provider Business Mailing Address
First Line	:	3208 E LOS ANGELES AVE
Second Line	:	SUITE 33
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-6107
Country	:	US
Telephone Number	:	805-584-2553
Fax Number	:	805-584-1410

Provider Business Practice Location Address
First Line	:	3208 E LOS ANGELES AVE
Second Line	:	SUITE 33
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-6107
Country	:	US
Telephone Number	:	805-584-2553
Fax Number	:	805-584-1410

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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