Individual provider Active NPI

Olivia Nguyen, DDS

  • General Practice Dentistry
  • Garden Grove, CA
National Provider Identifier
1396104758
Registry record updated Mar 17, 2018
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
100471 Issued in CA
Practice address
9862 Chapman Ave Ste B
Garden Grove, CA 92841-2726
Phone
(714) 531-0530
NPI assigned
Feb 15, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X 100471 CA Primary

Addresses

Primary practice location

9862 Chapman Ave Ste B
Garden Grove, CA 92841-2726

Mailing address

9862 Chapman Ave Ste B
Garden Grove, CA 92841-2726

Other practice location 1

345 9th St
Suite 302
Oakland, CA 94607-6522
Phone (510) 986-6888

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
I20161219002610 CA Order and Referring Only - DentistPractitioner - Dentist 8527349141

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
100471CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1396104758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9862 CHAPMAN AVE STE B",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928412726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9862 CHAPMAN AVE STE B",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928412726",
            "telephone_number": "714-531-0530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 9th St",
            "address_2": "Suite 302",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946076522",
            "country_code": "US",
            "telephone_number": "510-986-6888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "OLIVIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-15",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "100471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.