MEDICARE: DUNG T.P. NGUYEN DENTAL CORPORATION

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	1223P0700X	Prosthodontics	42749	CA

General Provider Information

NPI Number	:	1518021500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNG T.P. NGUYEN DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	3426 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2201
Country	:	US
Telephone Number	:	619-281-2186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3426 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2201
Country	:	US
Telephone Number	:	619-281-2186
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DUNG THI PHUONG NGUYEN
Credential	:	DDSQ
Telephone Number	:	619-281-2186

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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