Healthcare Provider Details

I. General information

NPI: 1356277156
Provider Name (Legal Business Name): JASON NGUYEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 1ST ST STE 110
SANTA ANA CA
92701-5243
US

IV. Provider business mailing address

210 W 1ST ST STE 110
SANTA ANA CA
92701-5243
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-1020
  • Fax: 714-543-1251
Mailing address:
  • Phone: 714-543-1020
  • Fax: 714-543-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON KHOA NGUYEN
Title or Position: DDS/OWNER
Credential: DDS
Phone: 661-827-1100