Provider Demographics
NPI:1225220890
Name:NGUYEN, VAN KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:KIM
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 1:7442 SONOMA CREEK CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1878
Mailing Address - Country:US
Mailing Address - Phone:714-251-9530
Mailing Address - Fax:714-623-1177
Practice Address - Street 1:1182 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5833
Practice Address - Country:US
Practice Address - Phone:909-623-1199
Practice Address - Fax:909-623-1177
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice