Healthcare Provider Details

I. General information

NPI: 1083823751
Provider Name (Legal Business Name): LUAN D NGUYEN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR SUITE 140
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR SUITE 140
FOOTHILL RANCH CA
92610-2844
US

V. Phone/Fax

Practice location:
  • Phone: 949-595-4322
  • Fax: 949-398-0199
Mailing address:
  • Phone: 949-595-4322
  • Fax: 949-398-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51769
License Number StateCA

VIII. Authorized Official

Name: DR. LUAN DINH NGUYEN
Title or Position: DENTIST, OWNER
Credential: DDS
Phone: 949-595-4322