1861603870 NPI number — MINH B. NGUYEN, DDS

Table of content: (NPI 1861603870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861603870 NPI number — MINH B. NGUYEN, DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINH B. NGUYEN, DDS
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:
SUN-PARK 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:
1861603870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 SUNSET BLVD STE 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95765-4784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-435-1155
Provider Business Mailing Address Fax Number:
916-435-1152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 SUNSET BLVD STE 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95765-4784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-435-1155
Provider Business Practice Location Address Fax Number:
916-435-1152
Provider Enumeration Date:
05/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
MINH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-435-1155

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  45506 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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