Healthcare Provider Details

I. General information

NPI: 1508957812
Provider Name (Legal Business Name): HENRY NGUYEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14520 NEWPORT AVE STE A
TUSTIN CA
92780-1019
US

IV. Provider business mailing address

14520 NEWPORT AVE STE A
TUSTIN CA
92780-1019
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-9800
  • Fax:
Mailing address:
  • Phone: 714-544-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: