Healthcare Provider Details

I. General information

NPI: 1437184769
Provider Name (Legal Business Name): BOITRAN CAO NGUYEN D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 CUYAMACA ST STE 103
SANTEE CA
92071-2689
US

IV. Provider business mailing address

9560 CUYAMACA ST STE 103
SANTEE CA
92071-2689
US

V. Phone/Fax

Practice location:
  • Phone: 619-448-5773
  • Fax: 619-448-5770
Mailing address:
  • Phone: 619-448-5773
  • Fax: 619-448-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: