Provider Demographics
NPI:1356494082
Name:NGUYEN, LINDA (DDS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
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 1:4106 SAN FERNANDO RD STE D
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3821
Mailing Address - Country:US
Mailing Address - Phone:818-549-2227
Mailing Address - Fax:818-549-2228
Practice Address - Street 1:4106 SAN FERNANDO RD STE D
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3821
Practice Address - Country:US
Practice Address - Phone:323-804-4098
Practice Address - Fax:818-549-2227
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9136401OtherDENTICAL PROVIDER NUMBER
CAD41971OtherRENDERING PROVIDER NUMBER