Healthcare Provider Details

I. General information

NPI: 1891908521
Provider Name (Legal Business Name): JASON SON NGOC NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SON NGUYEN DDS

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 S GLASSELL ST
ORANGE CA
92866-1918
US

IV. Provider business mailing address

262 S GLASSELL ST
ORANGE CA
92866-1918
US

V. Phone/Fax

Practice location:
  • Phone: 714-630-4589
  • Fax:
Mailing address:
  • Phone: 714-202-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number48970
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: