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General NPI Number Information
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NPI Number | 1356966972
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Entity Type | Individual
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Provider Name | KRISTIN NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 404 N EUCLID ST
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City | SANTA ANA
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State | CA
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Zip | 92703-2414
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Country | US
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Telephone | 949-616-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 7 PRIMAVERA
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City | IRVINE
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State | CA
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Zip | 92614-5313
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RES.004473
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 106987
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License Number State | CA
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