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General NPI Number Information
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NPI Number | 1639517394
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Entity Type | Organization
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Legal Business Name | KHUONG NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 2780 CARDINAL RD STE A
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City | SAN DIEGO
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State | CA
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Zip | 92123-3354
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Country | US
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Telephone | 858-650-0838
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Fax | 858-650-0836
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Provider Business Mailing Address
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Address Line | 2780 CARDINAL RD STE A
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City | SAN DIEGO
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State | CA
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Zip | 92123-3354
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Country | US
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Telephone | 858-650-0838
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Fax | 858-650-0836
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Authorized Official
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Title or Position | OWNER
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Name | DR. KHUONG HUU NGUYEN
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Credential | D.D.S
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Telephone | 858-650-0838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 44965
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License Number State | CA
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