Healthcare Provider Details

I. General information

NPI: 1447123138
Provider Name (Legal Business Name): KEVIN NGUYEN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20932 BROOKHURST ST STE 103
HUNTINGTON BEACH CA
92646-6685
US

IV. Provider business mailing address

20932 BROOKHURST ST STE 103
HUNTINGTON BEACH CA
92646-6685
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-3319
  • Fax:
Mailing address:
  • Phone: 714-962-3319
  • Fax: 714-962-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN NGUYEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 714-261-8673