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General NPI Number Information
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NPI Number | 1376610717
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Entity Type | Organization
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Legal Business Name | MY LINH THI NGUYEN DDS INC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 1840 N HACIENDA BLVD #5
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City | LA PUENTE
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State | CA
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Zip | 91744
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Country | US
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Telephone | 626-918-2833
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Fax | 626-931-2212
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Provider Business Mailing Address
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Address Line | 1840 N HACIENDA BLVD #5
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City | LA PUENTE
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State | CA
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Zip | 91744
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Country | US
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Telephone | 626-918-2833
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Fax | 626-931-2212
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | MY LINH THI NGUYEN
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Credential | DDS
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Telephone | 626-918-2833
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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 | 44043
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License Number State | CA
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