Provider Demographics
NPI:1861511420
Name:NGUYEN, KENNETH THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:THI
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 1:762 GLENDORA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-4044
Mailing Address - Country:US
Mailing Address - Phone:626-333-7920
Mailing Address - Fax:626-330-7019
Practice Address - Street 1:762 GLENDORA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4044
Practice Address - Country:US
Practice Address - Phone:626-333-7920
Practice Address - Fax:626-330-7019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice