Provider Demographics
NPI:1124244348
Name:JAMES A NGUYEN DDS A DENTAL CORP
Entity type:Organization
Organization Name:JAMES A NGUYEN DDS A DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-946-1052
Mailing Address - Street 1:1738 AVIATION BLVD.
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278
Mailing Address - Country:US
Mailing Address - Phone:310-372-4900
Mailing Address - Fax:310-372-4945
Practice Address - Street 1:1738 AVIATION BLVD.
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278
Practice Address - Country:US
Practice Address - Phone:310-372-4900
Practice Address - Fax:310-372-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty