Provider Demographics
NPI:1053525022
Name:NGUYEN, CHAU N (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAU
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2414
Mailing Address - Country:US
Mailing Address - Phone:323-567-2137
Mailing Address - Fax:323-567-5514
Practice Address - Street 1:8420 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2414
Practice Address - Country:US
Practice Address - Phone:323-567-2137
Practice Address - Fax:323-567-5514
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41494Medicaid
CAG91127-01Medicaid