Healthcare Provider Details

I. General information

NPI: 1750997011
Provider Name (Legal Business Name): ANISHA NGUYEN DDS PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 W EDINGER AVE STE E
SANTA ANA CA
92704-1969
US

IV. Provider business mailing address

10551 CLAUSSEN ST
GARDEN GROVE CA
92840-5040
US

V. Phone/Fax

Practice location:
  • Phone: 714-775-0650
  • Fax:
Mailing address:
  • Phone: 714-651-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANISHA NGUYEN
Title or Position: CEO
Credential: DDS
Phone: 714-651-6725