=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417042177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOANG THANH NGUYEN, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 12/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4233 W CENTURY BLVD STE 4
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90304-3646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-671-8535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4233 W CENTURY BLVD STE 4
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90304-3646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-671-8535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESEDENT
-----------------------------------------------------
Name | DR. HOANG THANH NGUYEN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 310-671-8535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 37268
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------