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General NPI Number Information
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NPI Number | 1679420020
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Entity Type | Individual
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Provider Name | MATTHEW QUE NGUYEN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 714 TIVERTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90095-8361
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Country | US
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Telephone | 310-825-5619
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 BELOIT AVE APT 203E
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City | LOS ANGELES
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State | CA
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Zip | 90025-1725
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Country | US
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Telephone | 510-672-2910
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 112763
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License Number State | CA
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