Provider Demographics
NPI:1356488829
Name:LE-NGUYEN DENTAL INC
Entity Type:Organization
Organization Name:LE-NGUYEN DENTAL INC
Other - Org Name:EL PORTAL DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANG
Authorized Official - Middle Name:CONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-385-1479
Mailing Address - Street 1:3393 G ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0964
Mailing Address - Country:US
Mailing Address - Phone:209-385-1479
Mailing Address - Fax:209-723-7087
Practice Address - Street 1:3393 G ST
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0964
Practice Address - Country:US
Practice Address - Phone:209-385-1479
Practice Address - Fax:209-723-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519841223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty