MEDICARE: KALVIN NGUYEN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1548910813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALVIN NGUYEN DDS PC

Provider Business Mailing Address
First Line	:	19201 BROOKHURST ST STE 103
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2926
Country	:	US
Telephone Number	:	657-800-5254
Fax Number	:

Provider Business Practice Location Address
First Line	:	19201 BROOKHURST ST STE 103
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2926
Country	:	US
Telephone Number	:	657-800-5254
Fax Number	:	657-800-5255

Authorized Official
Title or Position	:	DR.
Name	:	KALVIN ALEXANDER NGUYEN
Credential	:	DDS
Telephone Number	:	310-988-0658

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	01/22/2024

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