Healthcare Provider Details

I. General information

NPI: 1780539239
Provider Name (Legal Business Name): KIM YEN NGUYEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24601 RAYMOND WAY STE 5
LAKE FOREST CA
92630-4460
US

IV. Provider business mailing address

24601 RAYMOND WAY STE 5
LAKE FOREST CA
92630-4460
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-1130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KIM YEN NGUYEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 626-416-8311