Healthcare Provider Details

I. General information

NPI: 1225474414
Provider Name (Legal Business Name): PHUONG-TRINH NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6552 BOLSA, STE. L
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

6552 BOLSA, STE. L
HUNTINGTON BEACH CA
92647
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-7007
  • Fax: 949-644-0446
Mailing address:
  • Phone: 949-759-7007
  • Fax: 949-644-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: