Provider Demographics
NPI:1104955111
Name:NGUYEN, VICTORIA LOAN (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13112 NEWPORT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3425
Mailing Address - Country:US
Mailing Address - Phone:714-734-8588
Mailing Address - Fax:714-734-6646
Practice Address - Street 1:13112 NEWPORT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3425
Practice Address - Country:US
Practice Address - Phone:714-734-8588
Practice Address - Fax:714-734-6646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice