Provider Demographics
NPI:1053450924
Name:NGUYEN, SON V (DDS)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 BOLSA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5593
Mailing Address - Country:US
Mailing Address - Phone:714-379-2560
Mailing Address - Fax:714-379-2580
Practice Address - Street 1:9039 BOLSA AVE STE 116
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5593
Practice Address - Country:US
Practice Address - Phone:714-379-2560
Practice Address - Fax:714-379-2580
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93065-02OtherDENTI-CAL PROVIDER NUMBER