Provider Demographics
NPI:1245300318
Name:NGUYEN, TRANG MINH (DDS)
Entity type:Individual
Prefix:
First Name:TRANG
Middle Name:MINH
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 1:9246 VALLEY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1922
Mailing Address - Country:US
Mailing Address - Phone:626-573-3654
Mailing Address - Fax:626-573-3754
Practice Address - Street 1:9246 VALLEY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1922
Practice Address - Country:US
Practice Address - Phone:626-573-3654
Practice Address - Fax:626-573-3754
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41968-02OtherDENTI-CAL PROVIDER #