Provider Demographics
NPI:1629792957
Name:NGUYEN, HEATHER CATHERINE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CATHERINE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5967 WOODLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1075
Mailing Address - Country:US
Mailing Address - Phone:818-876-2838
Mailing Address - Fax:
Practice Address - Street 1:16830 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1707
Practice Address - Country:US
Practice Address - Phone:818-876-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist