=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699381319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DE NGUYEN DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2020
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14501 MAGNOLIA ST STE 107
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-248-9883
-----------------------------------------------------
Fax | 714-248-9774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14501 MAGNOLIA ST STE 107
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-248-9883
-----------------------------------------------------
Fax | 714-248-9774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DE GIAP NGUYEN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 562-506-6244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------