MEDICARE: PHUONGTRINH NGUYEN, DDS, APC

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	40101	CA

General Provider Information

NPI Number	:	1972720845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHUONGTRINH NGUYEN, DDS, APC

Provider Business Mailing Address
First Line	:	2150 E SOUTH ST
Second Line	:	SUITE 116
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4457
Country	:	US
Telephone Number	:	562-531-9779
Fax Number	:	562-531-9778

Provider Business Practice Location Address
First Line	:	2150 E SOUTH ST
Second Line	:	SUITE 116
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4457
Country	:	US
Telephone Number	:	562-531-9779
Fax Number	:	562-531-9778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHUONGTRINH N NGUYEN
Credential	:	DDS
Telephone Number	:	562-531-9779

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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