Provider Demographics
NPI:1740409374
Name:NGUYEN, HOANG CAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:CAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W 6TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3196
Mailing Address - Country:US
Mailing Address - Phone:951-898-2101
Mailing Address - Fax:951-898-2104
Practice Address - Street 1:1303 W 6TH ST STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3196
Practice Address - Country:US
Practice Address - Phone:951-898-2101
Practice Address - Fax:951-898-2104
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47968Medicaid