Provider Demographics
NPI:1851907380
Name:NGUYEN, KEVIN THANH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11841 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2338
Mailing Address - Country:US
Mailing Address - Phone:213-342-6325
Mailing Address - Fax:
Practice Address - Street 1:1001 E CHAPMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3851
Practice Address - Country:US
Practice Address - Phone:714-332-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice