Provider Demographics
NPI:1265558076
Name:NGUYEN, KHOI BINH (DDS)
Entity type:Individual
Prefix:MR
First Name:KHOI
Middle Name:BINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12082 HENRY EVANS DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3376
Mailing Address - Country:US
Mailing Address - Phone:949-842-6151
Mailing Address - Fax:714-680-5995
Practice Address - Street 1:508 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2411
Practice Address - Country:US
Practice Address - Phone:714-680-9595
Practice Address - Fax:714-680-5995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94138-01Medicaid