Provider Demographics
NPI:1699221598
Name:NGUYEN, JENNIFER THAO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:THAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NGUYEN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:888 S FIGUEROA ST STE 750
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2776
Mailing Address - Country:US
Mailing Address - Phone:530-436-5717
Mailing Address - Fax:
Practice Address - Street 1:888 S FIGUEROA ST STE 750
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2776
Practice Address - Country:US
Practice Address - Phone:530-436-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist