Provider Demographics
NPI:1669569679
Name:NGUYEN, KYRA TRANG (DDS)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:TRANG
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 1:3835 E ROLLING GREEN LANE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867
Mailing Address - Country:US
Mailing Address - Phone:714-998-5056
Mailing Address - Fax:714-528-4357
Practice Address - Street 1:525 S VALENCIA AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92823
Practice Address - Country:US
Practice Address - Phone:714-528-4355
Practice Address - Fax:714-528-4357
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist