Provider Demographics
NPI:1568541191
Name:NGUYEN, KHOI NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHOI
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21605 MARJORIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6419
Mailing Address - Country:US
Mailing Address - Phone:310-844-5490
Mailing Address - Fax:
Practice Address - Street 1:29273 CENTRAL AVE
Practice Address - Street 2:SUITE # A
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2254
Practice Address - Country:US
Practice Address - Phone:951-245-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice