Healthcare Provider Details

I. General information

NPI: 1518021500
Provider Name (Legal Business Name): DUNG T.P. NGUYEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 UNIVERSITY AVE
SAN DIEGO CA
92104-2201
US

IV. Provider business mailing address

3426 UNIVERSITY AVE
SAN DIEGO CA
92104-2201
US

V. Phone/Fax

Practice location:
  • Phone: 619-281-2186
  • Fax:
Mailing address:
  • Phone: 619-281-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number42749
License Number StateCA

VIII. Authorized Official

Name: DUNG THI PHUONG NGUYEN
Title or Position: PRESIDENT
Credential: DDSQ
Phone: 619-281-2186