Active NPI
Thanh Duc Nguyen, DMD
- Dentist
- Fountain Valley, CA
National Provider Identifier
1093854788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 53473
- Practice address
- 9520 Warner Ave Ste B
Fountain Valley, CA 92708-2857 - Phone
- (714) 377-0117
- Fax
- (714) 377-0177
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 53473 | CA | Primary |
Addresses
Primary practice location
9520 Warner Ave Ste B
Fountain Valley, CA 92708-2857
Mailing address
9520 Warner Ave Ste B
Fountain Valley, CA 92708-2857
Phone (714) 377-0117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053473 | Other | CA | MEDICAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53473 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Timothy Tien DDS PC | Past | Accepting new patients | |
| Boulevard Dental Center | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- San Diego, CA
- NPI 1780728436
-
dba Boulevard Dental Center
- General Practice Dentistry
- San Diego, CA
- NPI 1275837171
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761177600000",
"number": "1093854788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9520 WARNER AVE STE B",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082857",
"telephone_number": "714-377-0117",
"fax_number": "714-377-0177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9520 WARNER AVE STE B",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927082857",
"telephone_number": "714-377-0117",
"fax_number": "714-377-0177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "THANH DUC",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2025-10-23",
"certification_date": "2025-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "53473",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "053473",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.