| None | |
|
4575 El Cajon Blvd Ste A San Diego CA 92115-4390 | |
| (619) 281-5569 | |
| (619) 281-5559 |
| Full Name | None |
|---|---|
| Speciality | Dentist |
| Location | 4575 El Cajon Blvd Ste A, San Diego, California |
| Authorized Official Name and Position | Jonathan Chuong Le Nguyen (DENTIST) |
| Authorized Official Contact | 6192815569 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 4575 El Cajon Blvd Ste A San Diego CA 92115-4390 Ph: (619) 281-5569 | None 4575 El Cajon Blvd Ste A San Diego CA 92115-4390 Ph: (619) 281-5569 |
| NPI Number | 1104034982 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 11/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104034982 | NPI | - | NPPES |
| G9289201 | Other | CA | DENTICAL BILLING NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 51099 (California) | Primary |
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