Provider Demographics
NPI:1962036343
Name:TAN NGHIEM DDS INC
Entity Type:Organization
Organization Name:TAN NGHIEM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAN
Authorized Official - Middle Name:TRUNG
Authorized Official - Last Name:NGHIEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-800-9483
Mailing Address - Street 1:12130 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2817
Mailing Address - Country:US
Mailing Address - Phone:714-867-6226
Mailing Address - Fax:714-638-7114
Practice Address - Street 1:12130 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2817
Practice Address - Country:US
Practice Address - Phone:714-867-6226
Practice Address - Fax:714-638-7114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAN NGHIEM DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty