Healthcare Provider Details

I. General information

NPI: 1730413121
Provider Name (Legal Business Name): CUONG NGUYEN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5871 WESTMINSTER BLVD. SUITE G
WESTMINSTER CA
92683
US

IV. Provider business mailing address

5871 WESTMINSTER BLVD. SUITE G
WESTMINSTER CA
92683
US

V. Phone/Fax

Practice location:
  • Phone: 714-373-5999
  • Fax: 714-373-1999
Mailing address:
  • Phone: 714-373-5999
  • Fax: 714-373-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55918
License Number StateCA

VIII. Authorized Official

Name: DR. CUONG M. NGUYEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-373-5999