Individual provider Active NPI

Monique Nguyen

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Poway, CA
National Provider Identifier
1154089274
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
106704 Issued in CA
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

Updated by the provider on Jul 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220401001737 CA Order and Referring Only - DentistPractitioner - Dentist 7618363557

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DRPM2604FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ellen Im DDS Inc Orthodontics and Dentofacial Orthopedics PastSince Oct 25, 2020 Accepting new patients
Fedor Dental Corporation Dentist PastSince Dec 1, 2021 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.

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

Verify at the official NPI Registry.