Provider Demographics
NPI:1376667824
Name:NGUYEN, DIEP NGOC THI (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DIEP
Middle Name:NGOC THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:DIEP
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15361 BROOKHURST ST
Mailing Address - Street 2:#101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-839-2626
Mailing Address - Fax:714-839-6298
Practice Address - Street 1:15361 BROOKHURST ST
Practice Address - Street 2:#101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-839-2626
Practice Address - Fax:714-839-6298
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-28210-02OtherDENTICAL