Active NPI
Matthew Nguyen
- Pediatric Dentistry
- Los Angeles, CA
National Provider Identifier
1629693262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DDS107114
- Practice address
- 1417 S Westgate Ave PH 2
Los Angeles, CA 90025-5277 - Phone
- (818) 857-1154
- NPI assigned
- Jun 9, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DDS107114 | CA | Primary |
Addresses
Primary practice location
1417 S Westgate Ave PH 2
Los Angeles, CA 90025-5277
Mailing address
1417 S Westgate Ave PH 2
Los Angeles, CA 90025-5277
Other practice location 1
10582 W Pico Blvd
Los Angeles, CA 90064-2332
Phone (310) 837-6453
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS107114 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751328000000",
"number": "1629693262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1417 S WESTGATE AVE PH 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1417 S WESTGATE AVE PH 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255277",
"telephone_number": "818-857-1154"
}
],
"practiceLocations": [
{
"address_1": "10582 W Pico Blvd",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900642332",
"country_code": "US",
"telephone_number": "310-837-6453",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NGUYEN",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-09",
"last_updated": "2025-07-01",
"certification_date": "2025-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "DDS107114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.