Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 46206 | CA |
NPI | 1033234257 |
---|---|
Provider Name | Thien Phuc Nguyen |
First Address | Fullerton, CA 92835-3419 |
Second Address | Fullerton, CA 92835-3419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |