Individual provider Active NPI

Mai Thi Nguyen-Tu, D.D.S.

  • General Practice Dentistry
  • Pomona, CA
National Provider Identifier
1730307380
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
31096 Issued in CA
Practice address
1922 S Garey Ave
Pomona, CA 91766-5724
Phone
(909) 374-0851
NPI assigned
Apr 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 31096 CA Primary

Addresses

Primary practice location

1922 S Garey Ave
Pomona, CA 91766-5724

Mailing address

20376 E Crestline Dr
Walnut, CA 91789-4609
Phone (909) 374-0851

Other identifiers 1

IdentifierTypeStateIssuer
DENTICAL D31096OtherCADENTIST

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

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331856000000",
    "number": "1730307380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20376 E CRESTLINE DR",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917894609",
            "telephone_number": "909-374-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1922 S GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917665724",
            "telephone_number": "909-374-0851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN-TU",
        "first_name": "MAI",
        "middle_name": "THI",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2012-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "31096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "DENTICAL D31096",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.