Healthcare Provider Details

I. General information

NPI: 1750590048
Provider Name (Legal Business Name): BINH DUONG NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 MCKEE RD SUITE B
SAN JOSE CA
95116-1624
US

IV. Provider business mailing address

2351 MCKEE RD SUITE B
SAN JOSE CA
95116-1624
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-6394
  • Fax: 408-259-1015
Mailing address:
  • Phone: 408-259-6394
  • Fax: 408-259-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number35149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: