Active NPI
Monique Nguyen
- Orthodontics and Dentofacial Orthopedics Dentistry
- Poway, CA
National Provider Identifier
1154089274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 106704
- Practice address
- 13422 Pomerado Rd Ste 201
Poway, CA 92064-3548 - Phone
- (858) 679-6660
- NPI assigned
- Dec 6, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 106704 | CA | Primary |
Addresses
Primary practice location
13422 Pomerado Rd Ste 201
Poway, CA 92064-3548
Mailing address
13422 Pomerado Rd Ste 201
Poway, CA 92064-3548
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220401001737 | CA | Order and Referring Only - Dentist | 7618363557 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DRPM2604 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ellen Im DDS Inc | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
| Fedor Dental Corporation | Dentist | 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 and National Provider Directory roles.
-
- Pediatric Dentistry
- Poway, CA
- NPI 1861091720
Orthodontics and Dentofacial Orthopedics
-
- Dentist
- San Diego, CA
- NPI 1871071795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783382400000",
"number": "1154089274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13422 POMERADO RD STE 201",
"city": "POWAY",
"state": "CA",
"postal_code": "920643548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13422 POMERADO RD STE 201",
"city": "POWAY",
"state": "CA",
"postal_code": "920643548",
"telephone_number": "858-679-6660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "MONIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-06",
"last_updated": "2026-07-07",
"certification_date": "2026-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "106704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.