Healthcare Provider Details

I. General information

NPI: 1790816064
Provider Name (Legal Business Name): QUYNH A. TRAN-NGUYEN, D.M.D, DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD SUITE #138
THOUSAND OAKS CA
91320-6435
US

IV. Provider business mailing address

1000 NEWBURY RD SUITE #138
THOUSAND OAKS CA
91320-6435
US

V. Phone/Fax

Practice location:
  • Phone: 805-498-8856
  • Fax: 805-498-8867
Mailing address:
  • Phone: 805-498-8856
  • Fax: 805-498-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number52154
License Number StateCA

VIII. Authorized Official

Name: DR. QUYNH ANH TRAN-NGUYEN
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 805-498-8856