Healthcare Provider Details

I. General information

NPI: 1891994810
Provider Name (Legal Business Name): LOAN K. NGUYEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18821 DELAWARE ST., SUITE 206
HUNTINGTON BEACH CA
92648-9998
US

IV. Provider business mailing address

18821 DELAWARE ST., SUITE 206
HUNTINGTON BEACH CA
92648-9998
US

V. Phone/Fax

Practice location:
  • Phone: 714-465-9279
  • Fax: 714-847-0775
Mailing address:
  • Phone: 714-465-9279
  • Fax: 714-847-0775

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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number48652
License Number StateCA

VIII. Authorized Official

Name: DR. LOAN K NGUYEN
Title or Position: CEO
Credential: D.D.S.
Phone: 818-817-1807