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NPI Code Detail

MEDICARE: MATTHEW NGUYEN

MEDICARE:   MATTHEW  NGUYEN
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
11223G0001XGeneral Practice DentistryDN1858456MA
21223G0001XGeneral Practice DentistryDDS106377CA

General Provider Information

NPI Number : 1629639273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW NGUYEN
Provider Business Mailing Address
First Line : 1186 WINDMILL CT
Second Line :
City : SAN JOSE
State : CA
Zip : 95121-2365
Country : US
Telephone Number : 408-513-4030
Fax Number :
Provider Business Practice Location Address
First Line : 1186 WINDMILL CT
Second Line :
City : SAN JOSE
State : CA
Zip : 95121-2365
Country : US
Telephone Number : 408-513-4030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2019
Last Update Date : 12/15/2021

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Directions to “ MATTHEW NGUYEN ” Practice Location

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