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General NPI Number Information
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NPI Number | 1205320314
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Entity Type | Organization
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Legal Business Name | DR A NGUYEN DDS INC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 325 OLD NEWPORT BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4155
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Country | US
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Telephone | 714-478-5416
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Fax |
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Provider Business Mailing Address
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Address Line | 1431 HIGH BLUFF DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-8202
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Country | US
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Telephone | 714-478-5416
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANH LOAN NGUYEN
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Credential | DDS
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Telephone | 714-478-5416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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