Provider Demographics
NPI:1639268402
Name:NGUYEN, HUNG MANH (DDS)
Entity Type:Individual
Prefix:MR
First Name:HUNG
Middle Name:MANH
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 1:15671 BROOKHURST STREET
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7556
Mailing Address - Country:US
Mailing Address - Phone:714-839-3891
Mailing Address - Fax:714-839-3892
Practice Address - Street 1:15671 BROOKHURST STREET
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7556
Practice Address - Country:US
Practice Address - Phone:714-839-3891
Practice Address - Fax:714-839-3892
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38339Medicaid