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General NPI Number Information
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NPI Number | 1528411733
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Entity Type | Organization
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Legal Business Name | KENNETH NGUYEN, DDS APC
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 762 GLENDORA AVE STE D
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City | LA PUENTE
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State | CA
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Zip | 91744-4044
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Country | US
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Telephone | 626-333-7920
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Fax | 626-330-7019
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Provider Business Mailing Address
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Address Line | 762 GLENDORA AVE STE D
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City | LA PUENTE
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State | CA
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Zip | 91744-4044
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Country | US
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Telephone | 626-333-7920
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Fax | 626-330-7019
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH THI NGUYEN
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Credential |
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Telephone | 626-333-7920
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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 | 46204
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License Number State | CA
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