Provider Demographics
NPI:1710238944
Name:HUNG THU NGUYEN DDS & KEREN T NGUYEN DDS INC
Entity Type:Organization
Organization Name:HUNG THU NGUYEN DDS & KEREN T NGUYEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-962-2300
Mailing Address - Street 1:17037 BROOKHURST ST STE 4
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3623
Mailing Address - Country:US
Mailing Address - Phone:714-962-2300
Mailing Address - Fax:
Practice Address - Street 1:17037 BROOKHURST ST STE 4
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3623
Practice Address - Country:US
Practice Address - Phone:714-962-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty