Provider Demographics
NPI:1619295201
Name:KHANH V. NGUYEN, DDS, INC.
Entity Type:Organization
Organization Name:KHANH V. NGUYEN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:V
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:714-473-5479
Mailing Address - Street 1:3570 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4940
Mailing Address - Country:US
Mailing Address - Phone:619-298-8315
Mailing Address - Fax:619-298-4175
Practice Address - Street 1:3570 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4940
Practice Address - Country:US
Practice Address - Phone:619-298-8315
Practice Address - Fax:619-298-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty