MEDICARE: EPROSYSTEM INC.

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	261Q00000X	Clinic/Center	DDS36589	CA

General Provider Information

NPI Number	:	1609363423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPROSYSTEM INC.

Provider Business Mailing Address
First Line	:	3208 E LOS ANGELES AVE STE 33
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-6107
Country	:	US
Telephone Number	:	805-584-2802
Fax Number	:	805-584-1410

Provider Business Practice Location Address
First Line	:	3208 E LOS ANGELES AVE
Second Line	:	SUITE 33
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065
Country	:	US
Telephone Number	:	805-584-2802
Fax Number	:	805-584-1410

Authorized Official
Title or Position	:	PRESIDEENT
Name	:	DR. KHANG T NGUYEN
Credential	:	DDS
Telephone Number	:	805-584-2802

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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