Provider Demographics
NPI:1750052965
Name:LI & NGUYEN DENTAL CORP
Entity Type:Organization
Organization Name:LI & NGUYEN DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JINGJING
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-908-8905
Mailing Address - Street 1:3333 S BREA CANYON RD STE 121
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3783
Mailing Address - Country:US
Mailing Address - Phone:909-869-1098
Mailing Address - Fax:
Practice Address - Street 1:2707 E VALLEY BLVD STE 301
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3198
Practice Address - Country:US
Practice Address - Phone:909-908-8905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental