Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 50054035 | NY |
Y | 1223P0221X | Pediatric Dentist | 59162 | CA |
NPI | 1093971475 |
---|---|
Provider Name | Dr. Jeanne Thi Nguyen |
First Address | Fountain Valley, CA 92708-5842 |
Second Address | Rancho Santa Margarita, CA 92688-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 18/09/2012 |