Healthcare Provider Details

I. General information

NPI: 1013491190
Provider Name (Legal Business Name): DUY NGUYEN DDS, PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BILL DRAKE WAY STE B
PACIFICA CA
94044-1802
US

IV. Provider business mailing address

55 BILL DRAKE WAY STE B
PACIFICA CA
94044-1802
US

V. Phone/Fax

Practice location:
  • Phone: 650-735-1608
  • Fax: 888-509-8199
Mailing address:
  • Phone: 650-735-1608
  • Fax: 888-509-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DUY MINH NGUYEN
Title or Position: OWNER
Credential: DDS
Phone: 650-735-1608