Provider Demographics
NPI:1922029727
Name:NGUYEN, PAULINE (DDS)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
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 1:6039 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:30621-2306
Mailing Address - Country:US
Mailing Address - Phone:714-994-1456
Mailing Address - Fax:714-994-1530
Practice Address - Street 1:6039 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:30621-2306
Practice Address - Country:US
Practice Address - Phone:714-994-1456
Practice Address - Fax:714-994-1530
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9354001Medicaid