Provider Demographics
NPI:1164615027
Name:DU HUU NGUYEN,D.D.S.,INC.
Entity Type:Organization
Organization Name:DU HUU NGUYEN,D.D.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DU
Authorized Official - Middle Name:HUU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-599-8855
Mailing Address - Street 1:1305 W ARROW HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2336
Mailing Address - Country:US
Mailing Address - Phone:909-599-8855
Mailing Address - Fax:909-599-5333
Practice Address - Street 1:1305 W ARROW HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2336
Practice Address - Country:US
Practice Address - Phone:909-599-8855
Practice Address - Fax:909-599-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1223G0001XOtherDENTICAL