MEDICARE: DR. LIEN PHUONG 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	122300000X	Dentist	18504	MO
2	122300000X	Dentist	40100	CA

General Provider Information

NPI Number	:	1902865215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIEN PHUONG NGUYEN DDS

Provider Business Mailing Address
First Line	:	18225 HAMPTON CT
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5862
Country	:	US
Telephone Number	:	314-223-6251
Fax Number	:

Provider Business Practice Location Address
First Line	:	17214 NORWALK BLVD
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-2718
Country	:	US
Telephone Number	:	562-860-6011
Fax Number	:	562-860-7221

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/06/2022

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