Healthcare Provider Details

I. General information

NPI: 1700923844
Provider Name (Legal Business Name): KIMBERLY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21229 HAWTHORNE BLVD STE A
TORRANCE CA
90503-5501
US

IV. Provider business mailing address

21229 HAWTHORNE BLVD STE A
TORRANCE CA
90503-5501
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-5600
  • Fax: 310-792-5628
Mailing address:
  • Phone: 310-792-5600
  • Fax: 310-792-5628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: