Provider Demographics
NPI:1194979989
Name:NGUYEN, JIMMY TRUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:TRUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7990 STEPPING STONE CIR
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-4054
Mailing Address - Country:US
Mailing Address - Phone:714-372-3472
Mailing Address - Fax:
Practice Address - Street 1:7120 INDIANA AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4500
Practice Address - Country:US
Practice Address - Phone:951-276-2877
Practice Address - Fax:951-276-1124
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice