=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326596693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOAN D NGUYEN DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2016
-----------------------------------------------------
Last Update Date | 09/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 N SAN DIMAS AVE
-----------------------------------------------------
City | SAN DIMAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91773-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-599-1398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 N SAN DIMAS AVE
-----------------------------------------------------
City | SAN DIMAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91773-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-599-1398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TOAN NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-599-3398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------