Provider Demographics
NPI:1144229527
Name:NGUYEN, DUONG C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUONG
Middle Name:C
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 1:9900 MCFADDEN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6978
Mailing Address - Country:US
Mailing Address - Phone:714-418-2189
Mailing Address - Fax:714-418-2190
Practice Address - Street 1:9900 MCFADDEN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6978
Practice Address - Country:US
Practice Address - Phone:714-418-2189
Practice Address - Fax:714-418-2190
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD40174Medicaid
CAD40174Medicaid
CAD40174Medicare PIN