Healthcare Provider Details

I. General information

NPI: 1477654036
Provider Name (Legal Business Name): DAT QUOC NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9008 GARVEY AVE. STE B AND C
ROSEMEAD CA
91770-3360
US

IV. Provider business mailing address

14282 BROOKHURST ST STE 6
GARDEN GROVE CA
92843-4663
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-6733
  • Fax: 626-280-7906
Mailing address:
  • Phone: 714-531-6487
  • Fax: 714-531-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: