Provider Demographics
NPI:1558984138
Name:NGUYEN, CHI KIEU (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:KIEU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3734
Mailing Address - Country:US
Mailing Address - Phone:714-803-9064
Mailing Address - Fax:
Practice Address - Street 1:1000 S ANAHEIM BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5802
Practice Address - Country:US
Practice Address - Phone:714-635-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice