Provider Demographics
NPI:1487864856
Name:NGUYEN, KHOI PHAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KHOI
Middle Name:PHAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 WESTMINSTER AVE
Mailing Address - Street 2:#100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2133
Mailing Address - Country:US
Mailing Address - Phone:714-554-0700
Mailing Address - Fax:
Practice Address - Street 1:2708 WESTMINSTER AVE
Practice Address - Street 2:#100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2133
Practice Address - Country:US
Practice Address - Phone:714-554-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411474122300000X
CA57821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist