Healthcare Provider Details

I. General information

NPI: 1043072226
Provider Name (Legal Business Name): HUU NGUYEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E WESTERN AVE
AVONDALE AZ
85323-2348
US

IV. Provider business mailing address

2319 W ORANGE DR
PHOENIX AZ
85015-2739
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-3344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN THE HUU NGUYEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 602-290-2926