MEDICARE: TUAN HUU NGUYEN D.D.S.

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	43829	CA

General Provider Information

NPI Number	:	1669533311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUAN HUU NGUYEN D.D.S.

Provider Business Mailing Address
First Line	:	3347 GLENEAGLES DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1816
Country	:	US
Telephone Number	:	209-948-8400
Fax Number	:	209-948-8300

Provider Business Practice Location Address
First Line	:	1327 S MADISON ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206-1751
Country	:	US
Telephone Number	:	209-948-8400
Fax Number	:	209-948-8300

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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