Healthcare Provider Details

I. General information

NPI: 1255409694
Provider Name (Legal Business Name): MINH DUC NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12880 BEACH BLVD STUITE AA
STANTON CA
90680
US

IV. Provider business mailing address

3273 TURLOCK DR
COSTA MESA CA
92626-2124
US

V. Phone/Fax

Practice location:
  • Phone: 714-890-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: