Provider Demographics
NPI:1689074734
Name:SON NGUYEN D.D.S., INC.
Entity Type:Organization
Organization Name:SON NGUYEN D.D.S., INC.
Other - Org Name:LOTUS DENTAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SON
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-379-2560
Mailing Address - Street 1:730 E. VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776
Mailing Address - Country:US
Mailing Address - Phone:626-286-5600
Mailing Address - Fax:626-286-5605
Practice Address - Street 1:730 E VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-286-5600
Practice Address - Fax:626-286-5605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SON NGUYEN DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-26
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430491223X0400X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90365-01OtherDENTICAL