Organization
JIMMY NGUYEN D.D.S., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY NGUYEN (PRESIDENT/DENTIST)
(909) 890-9398
Entity
Organization
Contact information
Practice address
1918 BUSINESS CENTER DR, SUITE 210, SAN BERNARDINO, CA 92408-3439
(909) 890-9398
Mailing address
1918 BUSINESS CENTER DR, SUITE 210, SAN BERNARDINO, CA 92408-3439
(909) 890-9398
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
57891
CA
302R00000X
Health Maintenance Organization
57981
CA
305R00000X
Preferred Provider Organization
Primary
57981
CA
305S00000X
Point of Service
57981
CA
Other
Enumeration date
07/07/2014
Last updated
07/07/2014
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