MEDICARE: KHOA D. NGUYEN

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	39640	TX

General Provider Information

NPI Number	:	1912696147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHOA D. NGUYEN

Provider Business Mailing Address
First Line	:	715 TURNSTONE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-2339
Country	:	US
Telephone Number	:	682-269-5611
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 TURNSTONE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-2339
Country	:	US
Telephone Number	:	682-269-5611
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	06/23/2023

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