Individual
KELLY NGUYEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17781 SANTIAGO BLVD, ORANGE, CA 92861-4134
(714) 974-9000
Mailing address
803 POLARIS DR, TUSTIN, CA 92782-1721
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
102371
CA
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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