Provider Demographics
NPI:1528411733
Name:KENNETH NGUYEN, DDS APC
Entity Type:Organization
Organization Name:KENNETH NGUYEN, DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-333-7920
Mailing Address - Street 1:762 GLENDORA AVE
Mailing Address - Street 2:STE D
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-4044
Mailing Address - Country:US
Mailing Address - Phone:626-333-7920
Mailing Address - Fax:626-330-7019
Practice Address - Street 1:762 GLENDORA AVE
Practice Address - Street 2:STE D
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4044
Practice Address - Country:US
Practice Address - Phone:626-333-7920
Practice Address - Fax:626-330-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861511420OtherDENTAL