Provider Demographics
NPI:1912080409
Name:NGHIEM, VIET QUOC (DDS)
Entity Type:Individual
Prefix:MR
First Name:VIET
Middle Name:QUOC
Last Name:NGHIEM
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 1:12345 WESTMINSTER AVENUE
Mailing Address - Street 2:VIET NGHIEM DDS
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703
Mailing Address - Country:US
Mailing Address - Phone:714-554-2288
Mailing Address - Fax:714-554-2288
Practice Address - Street 1:12345 WESTMINSTER AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703
Practice Address - Country:US
Practice Address - Phone:714-554-2288
Practice Address - Fax:714-554-2288
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0341751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3417502Medicaid