Healthcare Provider Details

I. General information

NPI: 1932315041
Provider Name (Legal Business Name): LISA UYEN NGUYEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 SOUTH ST
ARTESIA CA
90701-6628
US

IV. Provider business mailing address

16345 PONDEROSA ST
FOUNTAIN VALLEY CA
92708-1932
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-4401
  • Fax: 526-924-1072
Mailing address:
  • Phone: 714-527-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: