MEDICARE: TUAN D NGUYEN, DDS, 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	122300000X	Dentist	45512	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G91926-01	OTHER	CA	DENTICAL PROVIDER ID

General Provider Information

NPI Number	:	1841375904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUAN D NGUYEN, DDS, INC

Provider Business Mailing Address
First Line	:	10431 LEMON AVE
Second Line	:	SUITE K
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3700
Country	:	US
Telephone Number	:	909-476-8303
Fax Number	:	909-476-8206

Provider Business Practice Location Address
First Line	:	10431 LEMON AVE
Second Line	:	SUITE K
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3700
Country	:	US
Telephone Number	:	909-476-8303
Fax Number	:	909-476-8206

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. TUAN D NGUYEN
Credential	:	DDS
Telephone Number	:	909-476-8303

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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