Provider Demographics
NPI:1316423023
Name:NGUYEN, SOPHIA (DMD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 W CLEARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3310
Mailing Address - Country:US
Mailing Address - Phone:714-890-2960
Mailing Address - Fax:
Practice Address - Street 1:2500 E IMPERIAL HWY STE 120
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6116
Practice Address - Country:US
Practice Address - Phone:714-990-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1027411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice