MEDICARE: DR. JENNIFER THAO NGUYEN DMD

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	122300000X	Dentist	100793	CA

General Provider Information

NPI Number	:	1699221598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER THAO NGUYEN DMD

Provider Business Mailing Address
First Line	:	888 S FIGUEROA ST STE 750
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2776
Country	:	US
Telephone Number	:	530-436-5717
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 S FIGUEROA ST STE 750
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2776
Country	:	US
Telephone Number	:	530-436-5717
Fax Number	:

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	12/17/2018

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