MEDICARE: MRS. DUNG LY NGUYEN SR. 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	41755	CA

General Provider Information

NPI Number	:	1467887943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DUNG LY NGUYEN SR. DDS

Provider Business Mailing Address
First Line	:	4310 EUCLID AVE
Second Line	:	#A
City	:	SAN DIEGO
State	:	CA
Zip	:	92115
Country	:	US
Telephone Number	:	619-281-6777
Fax Number	:	619-281-1987

Provider Business Practice Location Address
First Line	:	4310 EUCLID AVE
Second Line	:	#A
City	:	SAN DIEGO
State	:	CA
Zip	:	92115
Country	:	US
Telephone Number	:	619-281-6777
Fax Number	:	619-281-1987

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

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	09/04/2013

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