Provider Demographics
NPI:1104034982
Name:JONATHAN C. NGUYEN, DDS, INC.
Entity Type:Organization
Organization Name:JONATHAN C. NGUYEN, DDS, INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHUONG LE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-281-5569
Mailing Address - Street 1:4575 EL CAJON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4390
Mailing Address - Country:US
Mailing Address - Phone:619-281-5569
Mailing Address - Fax:619-281-5559
Practice Address - Street 1:4575 EL CAJON BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4390
Practice Address - Country:US
Practice Address - Phone:619-281-5569
Practice Address - Fax:619-281-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9289201OtherDENTICAL BILLING NUMBER
CAG9289201OtherDENTICAL BILLING NUMBER