Provider Demographics
NPI:1659954303
Name:NGUYEN, LISA (RDHAP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6131
Mailing Address - Country:US
Mailing Address - Phone:949-295-4704
Mailing Address - Fax:
Practice Address - Street 1:413 LUCENT DR
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-4024
Practice Address - Country:US
Practice Address - Phone:949-295-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27123124Q00000X
CAHAP905124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist