Healthcare Provider Details

I. General information

NPI: 1386844132
Provider Name (Legal Business Name): HOANG MINH NGUYEN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 INDIANA AVE STE. B
RIVERSIDE CA
92504-4500
US

IV. Provider business mailing address

1918 BUSINESS CENTER DR STE. 210
SAN BERNARDINO CA
92408-3439
US

V. Phone/Fax

Practice location:
  • Phone: 951-276-2877
  • Fax: 951-276-1124
Mailing address:
  • Phone: 909-890-9398
  • Fax: 951-276-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40867
License Number StateCA

VIII. Authorized Official

Name: DR. HOANG MINH NGUYEN
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 951-276-2877