Active NPI
Tracy Nguyen
- Dentist
- Orange, CA
National Provider Identifier
1801763644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112459
- Practice address
- 130 S Main St Ste a-D
Orange, CA 92868-2869 - Phone
- (657) 218-5865
- Fax
- (657) 295-2073
- NPI assigned
- Oct 17, 2025
- Last updated
- Oct 17, 2025
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 112459 | CA | Primary |
Addresses
Primary practice location
130 S Main St Ste a-D
Orange, CA 92868-2869
Mailing address
3210 Calle la Paz
Riverside, CA 92503-5283
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 |
|---|---|---|---|
| 112459 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elmira Latshikyan Dental Corporation | Current | Accepting new patients |
Locations
130 S Main St
Ste Ad
Orange, CA 92868
Phone (657) 218-5865
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Orange, CA
- NPI 1891532248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1760659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760659200000",
"number": "1801763644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3210 CALLE LA PAZ",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925035283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 S MAIN ST STE A-D",
"city": "ORANGE",
"state": "CA",
"postal_code": "928682869",
"telephone_number": "657-218-5865",
"fax_number": "657-295-2073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "TRACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-10-17",
"last_updated": "2025-10-17",
"certification_date": "2025-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "112459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.