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General NPI Number Information
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NPI Number | 1043695026
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Entity Type | Individual
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Provider Name | NGAN KIM NGUYEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 350 WESTPARK WAY STE 200
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City | EULESS
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State | TX
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Zip | 76040-3965
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Country | US
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Telephone | 817-283-5376
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 BRENDA DR
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City | IRVING
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State | TX
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Zip | 75060-6324
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Country | US
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Telephone | 469-878-6170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31234
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License Number State | TX
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