Provider Demographics
NPI:1992842421
Name:NGUYEN, LY MAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LY
Middle Name:MAI
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 1:1000 S ANAHEIM BLVD
Mailing Address - Street 2:STE. 103
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5801
Mailing Address - Country:US
Mailing Address - Phone:714-635-9999
Mailing Address - Fax:714-635-9998
Practice Address - Street 1:1000 S ANAHEIM BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5801
Practice Address - Country:US
Practice Address - Phone:714-635-9999
Practice Address - Fax:714-635-9998
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice