Provider Demographics
NPI:1053797456
Name:NGUYEN, CUONG QUOC (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:CUONG
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N. PACIFIC COAST HWY, SUITE 1150
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245
Mailing Address - Country:US
Mailing Address - Phone:310-322-1814
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:390 N. PACIFIC COAST HWY, SUITE 1150
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-322-1814
Practice Address - Fax:267-769-1596
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0404851223D0001X
CADDS103209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health