Healthcare Provider Details

I. General information

NPI: 1134411077
Provider Name (Legal Business Name): DIANA NGUYEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 SCRANTON RD SUITE 110
SAN DIEGO CA
92121-4720
US

IV. Provider business mailing address

9450 SCRANTON RD SUITE 110
SAN DIEGO CA
92121-4720
US

V. Phone/Fax

Practice location:
  • Phone: 858-490-4281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61904
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: