Provider Demographics
NPI:1639517394
Name:KHUONG NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:KHUONG NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:CLAIREMONT PEDIATRIC DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHUONG
Authorized Official - Middle Name:HUU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-650-0838
Mailing Address - Street 1:2780 CARDINAL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3354
Mailing Address - Country:US
Mailing Address - Phone:858-650-0838
Mailing Address - Fax:858-650-0836
Practice Address - Street 1:2780 CARDINAL RD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3354
Practice Address - Country:US
Practice Address - Phone:858-650-0838
Practice Address - Fax:858-650-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty