MEDICARE: DR. CHI KIM 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	122300000X	Dentist	DN15719	FL

General Provider Information

NPI Number	:	1558575589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHI KIM NGUYEN D.M.D.

Provider Business Mailing Address
First Line	:	5265 PARK BLVD
Second Line	:	SUITE 100
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781
Country	:	US
Telephone Number	:	727-545-9590
Fax Number	:	727-548-8590

Provider Business Practice Location Address
First Line	:	5265 PARK BLVD
Second Line	:	SUITE 100
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3451
Country	:	US
Telephone Number	:	727-545-9590
Fax Number	:	727-548-8590

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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