Provider Demographics
NPI:1164679379
Name:NGHIEM, TAN TRUNG (DDS)
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:TRUNG
Last Name:NGHIEM
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 1:5510 RHONDA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2456
Mailing Address - Country:US
Mailing Address - Phone:714-800-9483
Mailing Address - Fax:
Practice Address - Street 1:5510 RHONDA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2456
Practice Address - Country:US
Practice Address - Phone:714-800-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist