Healthcare Provider Details

I. General information

NPI: 1417428376
Provider Name (Legal Business Name): JENNIFER T. NGUYEN, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S FIGUEROA ST STE 750
LOS ANGELES CA
90017-2776
US

IV. Provider business mailing address

888 S FIGUEROA ST STE 750
LOS ANGELES CA
90017-2776
US

V. Phone/Fax

Practice location:
  • Phone: 213-340-3355
  • Fax:
Mailing address:
  • Phone: 213-340-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER NGUYEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 213-340-3355