Healthcare Provider Details

I. General information

NPI: 1609363423
Provider Name (Legal Business Name): EPROSYSTEM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 E LOS ANGELES AVE SUITE 33
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

3208 E LOS ANGELES AVE STE 33
SIMI VALLEY CA
93065-6107
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-2802
  • Fax: 805-584-1410
Mailing address:
  • Phone: 805-584-2802
  • Fax: 805-584-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDDS36589
License Number StateCA

VIII. Authorized Official

Name: DR. KHANG T NGUYEN
Title or Position: PRESIDEENT
Credential: DDS
Phone: 805-584-2802