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General NPI Number Information
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NPI Number | 1477031839
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Entity Type | Individual
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Provider Name | MICHAEL VIET NGUYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2018
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Last Update Date | 07/29/2018
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Provider Practice Location Address
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Address Line | 4233 W CENTURY BLVD STE 4
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City | INGLEWOOD
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State | CA
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Zip | 90304-3646
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Country | US
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Telephone | 310-671-8535
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Fax |
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Provider Business Mailing Address
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Address Line | 4233 W CENTURY BLVD
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City | INGLEWOOD
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State | CA
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Zip | 90304-1603
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102857
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License Number State | CA
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