Provider Demographics
NPI:1902028624
Name:NGUYEN, MINDY M (DDS)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HEWITT PL APT 4
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2677
Mailing Address - Country:US
Mailing Address - Phone:323-263-9064
Mailing Address - Fax:323-264-5655
Practice Address - Street 1:906 S SOTO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1323
Practice Address - Country:US
Practice Address - Phone:323-263-9064
Practice Address - Fax:323-264-5655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist