Individual provider Active NPI

David Nguyen, DDS

  • Dentist
  • Red Bluff, CA
National Provider Identifier
1104546167
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
107838 Issued in CA
Practice address
2500 Main St
Red Bluff, CA 96080-2336
Phone
(530) 529-2567
NPI assigned
Aug 30, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 107838 CA Primary

Addresses

Primary practice location

2500 Main St
Red Bluff, CA 96080-2336

Mailing address

404 Starbridge CT
Pleasant Hill, CA 94523-4723
Phone (714) 653-8394

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230113001319 TX Order and Referring Only - DentistPractitioner - Dentist 4688045404

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107838CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Valley Indian Health, Inc PastSince Sep 4, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1104546167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 STARBRIDGE CT",
            "city": "PLEASANT HILL",
            "state": "CA",
            "postal_code": "945234723",
            "telephone_number": "714-653-8394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 MAIN ST",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802336",
            "telephone_number": "530-529-2567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bluff, CA

Sources for this page

Verify at the official NPI Registry.