Provider Demographics
NPI:1588371736
Name:KHOI, JONATHAN NGUYEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NGUYEN
Last Name:KHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:ANH KHOI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 TIERRA LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1205
Mailing Address - Country:US
Mailing Address - Phone:408-838-4149
Mailing Address - Fax:
Practice Address - Street 1:5001 E RAMON RD STE 104
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1544
Practice Address - Country:US
Practice Address - Phone:760-283-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist