1942487582 NPI number — DR NGOC H NGUYEN D D S INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942487582 NPI number — DR NGOC H NGUYEN D D S INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR NGOC H NGUYEN D D S INC
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:
Provider Other Organization Name Type Code:
6
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:
1942487582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9390 BIG HORN BLVD
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95758-7978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-691-0685
Provider Business Mailing Address Fax Number:
916-691-0687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9390 BIG HORN BLVD
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758-7978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-691-0685
Provider Business Practice Location Address Fax Number:
916-691-0687
Provider Enumeration Date:
01/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
NGOC
Authorized Official Middle Name:
HOANG
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
916-691-0685

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  48837 , 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)

  • Identifier: B48837-02 . This is a "DDSGP-BILLING PROVIDER ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 101467 . This is a "DHA PRACTICE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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