Provider Demographics
NPI:1477657534
Name:NGUYEN, PHUONGTRINH NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONGTRINH
Middle Name:NGOC
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 1:2150 E SOUTH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4457
Mailing Address - Country:US
Mailing Address - Phone:562-531-9779
Mailing Address - Fax:562-531-9778
Practice Address - Street 1:2150 E SOUTH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4457
Practice Address - Country:US
Practice Address - Phone:562-531-9779
Practice Address - Fax:562-531-9778
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice