NPIMap

Organization Active NPI

Anthony D. Nguyen, DDS, Inc

Doing business as Pomona Valley Dental Practice

  • Preferred Provider Organization
  • Pomona, CA
National Provider Identifier
1104023647
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
47971 Issued in CA
Legal business name
ANTHONY D. NGUYEN, DDS, INC
Doing business as
Pomona Valley Dental Practice
Practice address
1290 N Garey Ave
Pomona, CA 91767-3806
Phone
(909) 623-1564
Fax
(909) 629-9126
NPI assigned
Jun 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anthony Dung Nguyen, DDSNPI 1821145079
Title
President
Phone
(909) 623-1564

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 47971 CA Primary

Addresses

Primary practice location

1290 N Garey Ave
Pomona, CA 91767-3806

Mailing address

1290 N Garey Ave
Pomona, CA 91767-3806
Phone (909) 623-1564

Other identifiers 1

IdentifierTypeStateIssuer
B4797101MedicaidCA

Other names 1

  • Pomona Valley Dental Practice Doing business as

National Provider Directory

National Provider Directory

Locations

1290 N Garey Ave
Pomona, CA 91767
Phone (909) 623-1564

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1104023647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673806",
            "telephone_number": "909-623-1564",
            "fax_number": "909-629-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673806",
            "telephone_number": "909-623-1564",
            "fax_number": "909-629-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY D. NGUYEN, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "DUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-623-1564",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "47971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B4797101",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pomona Valley Dental Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.