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General NPI Number Information
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NPI Number | 1346733573
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Entity Type | Organization
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Legal Business Name | ELIZABETH KIM NGUYEN DDS INC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 14521 RED HILL AVE
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-838-9912
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Fax | 714-838-9913
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Provider Business Mailing Address
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Address Line | 14521 RED HILL AVE
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City | TUSTIN
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State | CA
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Zip | 92780-6238
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Country | US
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Telephone | 714-838-9912
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Fax | 714-838-9913
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Authorized Official
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Title or Position | DDS
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Name | ELIZABETH K NGUYEN
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Credential |
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Telephone | 714-838-9912
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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 | 52762
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License Number State | CA
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