Healthcare Provider Details

I. General information

NPI: 1417042177
Provider Name (Legal Business Name): HOANG THANH NGUYEN, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 W CENTURY BLVD STE 4
INGLEWOOD CA
90304-3646
US

IV. Provider business mailing address

4233 W CENTURY BLVD STE 4
INGLEWOOD CA
90304-3646
US

V. Phone/Fax

Practice location:
  • Phone: 310-671-8535
  • Fax:
Mailing address:
  • Phone: 310-671-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37268
License Number StateCA

VIII. Authorized Official

Name: DR. HOANG THANH NGUYEN
Title or Position: PRESEDENT
Credential: D.D.S.
Phone: 310-671-8535