Healthcare Provider Details

I. General information

NPI: 1962076729
Provider Name (Legal Business Name): HOA N NGUYEN, DMD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28743 VALLEY CENTER RD STE A
VALLEY CENTER CA
92082-6530
US

IV. Provider business mailing address

28743 VALLEY CENTER RD STE A
VALLEY CENTER CA
92082-6530
US

V. Phone/Fax

Practice location:
  • Phone: 760-749-1123
  • Fax:
Mailing address:
  • Phone: 760-749-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HOA NGUYEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 714-474-1758