Healthcare Provider Details

I. General information

NPI: 1801179932
Provider Name (Legal Business Name): DUC NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CAMINO DEL RIO S STE 202
SAN DIEGO CA
92108-3520
US

IV. Provider business mailing address

1333 CAMINO DEL RIO S STE 202
SAN DIEGO CA
92108-3520
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: