MEDICARE: HA HEATHER 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	44044	CA

General Provider Information

NPI Number	:	1639298425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA HEATHER NGUYEN DDS

Provider Business Mailing Address
First Line	:	2121 SHIANGZONE CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1468
Country	:	US
Telephone Number	:	408-264-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 BRANHAM LN
Second Line	:	B4
City	:	SAN JOSE
State	:	CA
Zip	:	95118-5222
Country	:	US
Telephone Number	:	408-264-7630
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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