Provider Demographics
NPI:1912507203
Name:GEORGE K NGUYEN DDS, PC
Entity Type:Organization
Organization Name:GEORGE K NGUYEN DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KHOA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-273-9900
Mailing Address - Street 1:2097 COMPTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7289
Mailing Address - Country:US
Mailing Address - Phone:951-273-9900
Mailing Address - Fax:951-273-9991
Practice Address - Street 1:2097 COMPTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7289
Practice Address - Country:US
Practice Address - Phone:951-273-9900
Practice Address - Fax:951-273-9991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE K NGUYEN DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental