MEDICARE: THACHTU LE NGUYEN 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	1223G0001X	General Practice Dentistry	47651	CA

General Provider Information

NPI Number	:	1598963373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THACHTU LE NGUYEN DDS

Provider Business Mailing Address
First Line	:	1111 STORY RD
Second Line	:	STE #1037
City	:	SAN JOSE
State	:	CA
Zip	:	95122
Country	:	US
Telephone Number	:	408-999-0480
Fax Number	:	408-288-8212

Provider Business Practice Location Address
First Line	:	1111 STORY RD
Second Line	:	STE #1037
City	:	SAN JOSE
State	:	CA
Zip	:	95122
Country	:	US
Telephone Number	:	408-999-0480
Fax Number	:	408-288-8212

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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