Active NPI
Jessica Nguyen, DMD
- Endodontics
- Fresno, CA
National Provider Identifier
1639504632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 63583
- Practice address
- 6307 N Fresno St Ste 102
Fresno, CA 93710-5284 - Phone
- (559) 224-5423
- NPI assigned
- Sep 9, 2013
- Last updated
- Jan 31, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 63583 | CA | Primary |
Addresses
Primary practice location
6307 N Fresno St Ste 102
Fresno, CA 93710-5284
Mailing address
6307 N Fresno St Ste 102
Fresno, CA 93710-5284
Phone (559) 224-5423
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 |
|---|---|---|---|---|
| I20150915003323 | CA | Order and Referring Only - Dentist | 2163739624 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548892800000",
"number": "1639504632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6307 N FRESNO ST STE 102",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105284",
"telephone_number": "559-224-5423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6307 N FRESNO ST STE 102",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105284",
"telephone_number": "559-224-5423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "JESSICA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-09",
"last_updated": "2019-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "63583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; 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.