{
"Npi": {
"NPI": "1548910813",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KALVIN NGUYEN DDS PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "19201 BROOKHURST ST STE 103",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTINGTON BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92646-2926",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "657-800-5254",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19201 BROOKHURST ST STE 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HUNTINGTON BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92646-2926",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "657-800-5254",
"PracticeLocationAddressFaxNumber": "657-800-5255",
"EnumerationDate": "03/28/2022",
"LastUpdateDate": "01/22/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
"AuthorizedOfficialFirstName": "KALVIN",
"AuthorizedOfficialMiddleName": "ALEXANDER",
"AuthorizedOfficialTitle": "DR.",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "310-988-0658",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}