Provider Demographics
NPI:1295816742
Name:NGUYEN, JENNI HA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNI
Middle Name:HA
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 1:15972 EUCLID ST STE F
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1133
Mailing Address - Country:US
Mailing Address - Phone:714-839-7660
Mailing Address - Fax:714-839-7693
Practice Address - Street 1:15972 EUCLID ST STE F
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1133
Practice Address - Country:US
Practice Address - Phone:714-839-7660
Practice Address - Fax:714-839-7693
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90930-01Medicaid