Healthcare Provider Details

I. General information

NPI: 1952729691
Provider Name (Legal Business Name): CAO TU NGUYEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 SENTER RD STE 3
SAN JOSE CA
95112-2608
US

IV. Provider business mailing address

2114 SENTER RD STE 3
SAN JOSE CA
95112-2608
US

V. Phone/Fax

Practice location:
  • Phone: 408-993-8624
  • Fax: 408-298-4841
Mailing address:
  • Phone: 408-993-8624
  • Fax: 408-298-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31345
License Number StateCA

VIII. Authorized Official

Name: CAO TU NGUYEN
Title or Position: DENTIST
Credential: DDS
Phone: 408-993-8624