Provider Demographics
NPI:1720203631
Name:NGUYEN, JULIAN L (DMD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:L
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JULIAN
Other - Middle Name:L
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD INC
Mailing Address - Street 1:9040 HUNTINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775
Mailing Address - Country:US
Mailing Address - Phone:626-792-1755
Mailing Address - Fax:626-872-1901
Practice Address - Street 1:1090 LINDA VISTA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2749
Practice Address - Country:US
Practice Address - Phone:626-316-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice