Provider Demographics
NPI:1972720845
Name:PHUONGTRINH NGUYEN, DDS, APC
Entity type:Organization
Organization Name:PHUONGTRINH NGUYEN, DDS, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONGTRINH
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-531-9779
Mailing Address - Street 1:2150 E SOUTH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4457
Mailing Address - Country:US
Mailing Address - Phone:562-531-9779
Mailing Address - Fax:562-531-9778
Practice Address - Street 1:2150 E SOUTH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4457
Practice Address - Country:US
Practice Address - Phone:562-531-9779
Practice Address - Fax:562-531-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty