=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609363423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPROSYSTEM INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2018
-----------------------------------------------------
Last Update Date | 04/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3208 E LOS ANGELES AVE SUITE 33
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-584-2802
-----------------------------------------------------
Fax | 805-584-1410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3208 E LOS ANGELES AVE STE 33
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-6107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-584-2802
-----------------------------------------------------
Fax | 805-584-1410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDEENT
-----------------------------------------------------
Name | DR. KHANG T NGUYEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 805-584-2802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | DDS36589
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------