Provider Demographics
NPI:1487521431
Name:KHUYEN NGUYEN PC DBA THE GLEAMERY
Entity type:Organization
Organization Name:KHUYEN NGUYEN PC DBA THE GLEAMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDIO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-326-1789
Mailing Address - Street 1:2903 LINCOLN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2903 LINCOLN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5793
Practice Address - Country:US
Practice Address - Phone:213-326-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHUYEN NGUYEN PC DBA THE GLEAMERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty