Provider Demographics
NPI:1689193054
Name:NGUYEN, AN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 KERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5029
Mailing Address - Country:US
Mailing Address - Phone:949-545-4753
Mailing Address - Fax:
Practice Address - Street 1:9900 MCFADDEN AVE STE 204
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6978
Practice Address - Country:US
Practice Address - Phone:949-545-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist