Healthcare Provider Details

I. General information

NPI: 1699327031
Provider Name (Legal Business Name): TRI MINH NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG, 390 N LOOP RD,
FORT IRWIN CA
92310
US

IV. Provider business mailing address

105 CATALYST
IRVINE CA
92618
US

V. Phone/Fax

Practice location:
  • Phone: 832-633-4245
  • Fax:
Mailing address:
  • Phone: 832-633-4245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS112397
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS2-218
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: