Provider Demographics
NPI:1811015118
Name:NGUYEN, TUNG XUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TUNG
Middle Name:XUAN
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 1:2739 W EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-3523
Mailing Address - Country:US
Mailing Address - Phone:714-957-0308
Mailing Address - Fax:714-957-5845
Practice Address - Street 1:2739 W EDINGER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-3523
Practice Address - Country:US
Practice Address - Phone:714-957-0308
Practice Address - Fax:714-957-5845
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB29403-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29403-01Medicare ID - Type Unspecified
CA193971Medicare UPIN