Provider Demographics
NPI:1366733594
Name:NICK K. NGUYEN, DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NICK K. NGUYEN, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LY
Authorized Official - Middle Name:THIEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-215-4400
Mailing Address - Street 1:6B LIBERTY STE 120
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5833
Mailing Address - Country:US
Mailing Address - Phone:949-215-4400
Mailing Address - Fax:949-215-4402
Practice Address - Street 1:6B LIBERTY STE 120
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5833
Practice Address - Country:US
Practice Address - Phone:949-215-4400
Practice Address - Fax:949-215-4402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NGUYEN & YANG, A GENERAL PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48838261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6531980001Medicare NSC