Provider Demographics
NPI:1447869086
Name:NGUYEN, THERESA HOANG (DMD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NHI
Other - Middle Name:THANH
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:P.O. BOX 26338
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799
Mailing Address - Country:US
Mailing Address - Phone:951-733-9479
Mailing Address - Fax:
Practice Address - Street 1:22951 LOS ALISOS BLVD
Practice Address - Street 2:#2
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-380-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist