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General NPI Number Information
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NPI Number | 1598171993
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Entity Type | Organization
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Legal Business Name | JIMMY NGUYEN D.D.S., INC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 1918 BUSINESS CENTER DR SUITE 210
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3439
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Country | US
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Telephone | 909-890-9398
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 BUSINESS CENTER DR SUITE 210
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3439
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Country | US
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Telephone | 909-890-9398
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | JIMMY NGUYEN
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Credential |
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Telephone | 909-890-9398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 57891
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 57981
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 57981
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 57981
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License Number State | CA
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