Provider Demographics
NPI:1235583253
Name:KHOI BINH NGUYEN DENTAL CORPORATION
Entity Type:Organization
Organization Name:KHOI BINH NGUYEN DENTAL CORPORATION
Other - Org Name:SIMPLY DENTISTRY PRACTICE OF KHOI BIHN NGUYEN DENTAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHOI
Authorized Official - Middle Name:BINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-842-6151
Mailing Address - Street 1:17602 17TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1961
Mailing Address - Country:US
Mailing Address - Phone:714-450-8570
Mailing Address - Fax:
Practice Address - Street 1:17602 17TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1961
Practice Address - Country:US
Practice Address - Phone:714-450-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty