Healthcare Provider Details

I. General information

NPI: 1861300055
Provider Name (Legal Business Name): J. L. NGUYEN MD DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S BREA BLVD
BREA CA
92821-5301
US

IV. Provider business mailing address

428 S BREA BLVD
BREA CA
92821-5301
US

V. Phone/Fax

Practice location:
  • Phone: 714-987-2602
  • Fax:
Mailing address:
  • Phone: 714-987-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN NGUYEN
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential: MD, DMD
Phone: 714-987-2602