Healthcare Provider Details

I. General information

NPI: 1225212772
Provider Name (Legal Business Name): QUYNH NGUYEN DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 MONTPELIER DR SUITE 1
SAN JOSE CA
95116-1619
US

IV. Provider business mailing address

2395 MONTPELIER DR SUITE 1
SAN JOSE CA
95116-1619
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-2888
  • Fax:
Mailing address:
  • Phone: 408-272-2888
  • 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. QUYNH C NGUYEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 408-272-2888