Kietnguyen DMD Corp

Primary specialty

DentistTaxonomy code 122300000X

License

49169 Issued in CA

Legal business name

KIETNGUYEN DMD CORP

Practice address

9864 Katella Ave
Anaheim, CA 92804-6418

Phone

(714) 636-1112

Fax

(714) 636-1674

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Kiet Tuan Nguyen, DMDNPI 1598902967

Title

DMD President

Phone

(714) 636-1112

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kiet Nguyen DMD Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kiet Tuan Nguyen, DMD

  • General Practice Dentistry
  • Anaheim, CA
  • NPI 1598902967
  NPD (past) Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821196312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9864 KATELLA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928046418",
            "telephone_number": "714-636-1112",
            "fax_number": "714-636-1674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9864 KATELLA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928046418",
            "telephone_number": "714-636-1112",
            "fax_number": "714-636-1674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIETNGUYEN DMD CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KIET",
        "authorized_official_middle_name": "TUAN",
        "authorized_official_title_or_position": "DMD PRESIDENT",
        "authorized_official_telephone_number": "714-636-1112",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "49169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B4916901",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kiet Nguyen DMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.