Healthcare Provider Details

I. General information

NPI: 1548910813
Provider Name (Legal Business Name): KALVIN NGUYEN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 01/22/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19201 BROOKHURST ST STE 103
HUNTINGTON BEACH CA
92646-2926
US

IV. Provider business mailing address

19201 BROOKHURST ST STE 103
HUNTINGTON BEACH CA
92646-2926
US

V. Phone/Fax

Practice location:
  • Phone: 657-800-5254
  • Fax: 657-800-5255
Mailing address:
  • Phone: 657-800-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KALVIN ALEXANDER NGUYEN
Title or Position: DR.
Credential: DDS
Phone: 310-988-0658