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General NPI Number Information
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NPI Number | 1275105207
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Entity Type | Individual
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Provider Name | TIFFANY NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 1136 N MOUNT VERNON AVE # 202-203
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-2279
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Country | US
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Telephone | 909-453-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 827 S VALINDA AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-4347
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Country | US
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Telephone |
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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 | 106517
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License Number State | CA
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