=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861300055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. L. NGUYEN MD DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 S BREA BLVD
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-987-2602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 S BREA BLVD
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-987-2602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORAL AND MAXILLOFACIAL SURGEON
-----------------------------------------------------
Name | JUSTIN NGUYEN
-----------------------------------------------------
Credential | MD, DMD
-----------------------------------------------------
Telephone | 714-987-2602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------