Provider Demographics
NPI:1417125188
Name:NGUYEN, MY LINH THI (DDS)
Entity Type:Individual
Prefix:
First Name:MY LINH
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MY LINH
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1840 N HACIENDA BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1143
Mailing Address - Country:US
Mailing Address - Phone:626-918-2833
Mailing Address - Fax:626-931-2212
Practice Address - Street 1:1840 N HACIENDA BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-918-2833
Practice Address - Fax:626-931-2212
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91872-01OtherDENTI-CAL