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General NPI Number Information
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NPI Number | 1356876452
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Entity Type | Organization
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Legal Business Name | NGUYEN, GHORBANIAN
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 3153 YORBA LINDA BLVD
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City | FULLERTON
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State | CA
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Zip | 92831-2307
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Country | US
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Telephone | 714-986-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 3153 YORBA LINDA BLVD
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City | FULLERTON
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State | CA
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Zip | 92831-2307
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Country | US
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Telephone | 714-986-9902
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. ABRAHAM GHORBANIAN
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Credential |
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Telephone | 949-450-0076
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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 | 53515
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License Number State | CA
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