1871897389 NPI number — AN NGUYEN DDS PROF CORP

Table of content: (NPI 1871897389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871897389 NPI number — AN NGUYEN DDS PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AN NGUYEN DDS PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
29 PALMS DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871897389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73666 JOSHUA DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWENTYNINE PALMS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-865-0544
Provider Business Mailing Address Fax Number:
888-877-5510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73666 JOSHUA DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-865-0544
Provider Business Practice Location Address Fax Number:
888-877-5510
Provider Enumeration Date:
12/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
AN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
760-865-0544

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  56731 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 59641 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 57500 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1104963750 . This is a "INDIVIDUAL DENTAL PROVIDERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1780801969 . This is a "INDIVIDUAL DENTAL PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942538160 . This is a "INDIVIDUAL DENTAL PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".