Healthcare Provider Details

I. General information

NPI: 1215059696
Provider Name (Legal Business Name): JACQUELINE NGUYEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE B. NGUYEN D.D.S.

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 S WINCHESTER BLVD STE 100
CAMPBELL CA
95008-3473
US

IV. Provider business mailing address

5655 SILVER CREEK VALLEY RD # 749
SAN JOSE CA
95138-2473
US

V. Phone/Fax

Practice location:
  • Phone: 408-320-5251
  • Fax:
Mailing address:
  • Phone: 408-320-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: