Healthcare Provider Details

I. General information

NPI: 1457256596
Provider Name (Legal Business Name): KHUYEN NGUYEN PC DBA THE GLEAMERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11954 VENTURA BLVD
STUDIO CITY CA
91604-2606
US

IV. Provider business mailing address

11954 VENTURA BLVD
STUDIO CITY CA
91604-2606
US

V. Phone/Fax

Practice location:
  • Phone: 213-326-1789
  • Fax:
Mailing address:
  • Phone: 213-326-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AJ ESCOBAR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 213-326-1789