MEDICARE: MRS. DAT THI NGHIEM 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	41119	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	:	1568551356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAT THI NGHIEM DDS

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD. #1112
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-208-4084
Fax Number	:	310-824-1369

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD. #1112
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-208-4084
Fax Number	:	310-824-1369

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/16/2023

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