Provider Demographics
NPI:1093882029
Name:NGUYEN, KIMBERLY (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11352 RENAISSANCE WAY
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3430
Mailing Address - Country:US
Mailing Address - Phone:714-200-8489
Mailing Address - Fax:
Practice Address - Street 1:11352 RENAISSANCE WAY
Practice Address - Street 2:SUITE 1/2
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3066
Practice Address - Country:US
Practice Address - Phone:714-899-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice