Healthcare Provider Details

I. General information

NPI: 1003593336
Provider Name (Legal Business Name): MARK DINH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 BERRYESSA RD STE A
SAN JOSE CA
95133-1173
US

IV. Provider business mailing address

9251 AMBASSADOR DR
WESTMINSTER CA
92683-7416
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-4943
  • Fax:
Mailing address:
  • Phone: 714-823-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: