Provider Demographics
NPI:1588100705
Name:NGUYEN, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 IRVINE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3334
Mailing Address - Country:US
Mailing Address - Phone:949-654-8600
Mailing Address - Fax:949-654-8607
Practice Address - Street 1:4902 IRVINE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3334
Practice Address - Country:US
Practice Address - Phone:949-654-8600
Practice Address - Fax:949-654-8607
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist