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General NPI Number Information
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NPI Number | 1629792957
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Entity Type | Individual
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Provider Name | HEATHER CATHERINE NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 16830 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91436-1707
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Country | US
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Telephone | 818-876-2838
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Fax |
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Provider Business Mailing Address
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Address Line | 5967 WOODLAND VIEW DR
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-1075
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Country | US
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Telephone | 818-876-2838
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 107687
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License Number State | CA
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