Provider Demographics
NPI:1588877997
Name:NGUYEN, OLIVIA LAN HUONG
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:LAN HUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4046
Mailing Address - Country:US
Mailing Address - Phone:714-899-4222
Mailing Address - Fax:
Practice Address - Street 1:7744 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4046
Practice Address - Country:US
Practice Address - Phone:714-899-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD322211223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92180-02OtherHEALTHY FAMILIES
CAG90584-01OtherMEDICAL
CA943419806OtherTAX ID NO.
CAD32221OtherLICENSE NUMBER