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General NPI Number Information
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NPI Number | 1780134478
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Entity Type | Organization
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Legal Business Name | DR. BAO LUU NGUYEN DDS INC.
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST SUITE # W 127
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City | SANTA ANA
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State | CA
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Zip | 92701-2201
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Country | US
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Telephone | 714-541-9203
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Fax |
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Provider Business Mailing Address
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Address Line | 21216 COLD SPRING LN
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3440
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Country | US
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Telephone | 714-541-9203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BAO LUU NGUYEN
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Credential | DDS
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Telephone | 714-541-9203
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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 | 42378
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License Number State | CA
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