MEDICARE: DUNG LY 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	1223G0001X	General Practice Dentistry	41755	CA

General Provider Information

NPI Number	:	1922170612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNG LY NGUYEN, DDS, INC

Provider Business Mailing Address
First Line	:	4310 EUCLID AVE STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4995
Country	:	US
Telephone Number	:	619-281-6777
Fax Number	:	619-281-1987

Provider Business Practice Location Address
First Line	:	4310 EUCLID AVE STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4995
Country	:	US
Telephone Number	:	619-281-6777
Fax Number	:	619-281-1987

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DUNG LY NGUYEN
Credential	:	D.D.S
Telephone Number	:	619-281-6777

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/22/2020

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