Provider Demographics
NPI:1841329976
Name:NGUYEN, JONATHAN THIEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THIEN
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 1:2424 SEPULVEDA BLVD STE N
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-4335
Mailing Address - Country:US
Mailing Address - Phone:310-534-0025
Mailing Address - Fax:310-534-0026
Practice Address - Street 1:2424 SEPULVEDA BLVD STE N
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4335
Practice Address - Country:US
Practice Address - Phone:310-534-0025
Practice Address - Fax:310-534-0026
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice