Provider Demographics
NPI:1124644315
Name:NGUYEN, NANCY THANH TAM (RDH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:THANH TAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10682 SENNIT AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5336
Mailing Address - Country:US
Mailing Address - Phone:714-856-4286
Mailing Address - Fax:
Practice Address - Street 1:2002 S HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1323
Practice Address - Country:US
Practice Address - Phone:310-858-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26646124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist