Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 43049 | CA |
NPI | 1053450924 |
---|---|
Provider Name | Son V Nguyen |
First Address | Westminster, CA 92683-5593 |
Second Address | Westminster, CA 92683-5593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 07/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G93065-02 | DENTI-CAL PROVIDER NUMBER (01) | CA |