Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 59352 | CA |
NPI | 1083802003 |
---|---|
Provider Name | Dr. Quoc Lap Nguyen |
First Address | Laguna Hills, CA 92653-4342 |
Second Address | Laguna Hills, CA 92653-4342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 12/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59352 | DENTAL BOARD OF CALIFORNIA (01) | CA |