Healthcare Provider Details

I. General information

NPI: 1194273458
Provider Name (Legal Business Name): TOAN NGUYEN DDS A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17732 BEACH BLVD STE A
HUNTINGTON BEACH CA
92647-6881
US

IV. Provider business mailing address

17732 BEACH BLVD STE A
HUNTINGTON BEACH CA
92647-6881
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-0601
  • Fax:
Mailing address:
  • Phone: 714-842-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TOAN D NGUYEN
Title or Position: OWNER
Credential: DDS
Phone: 714-842-0601