Healthcare Provider Details

I. General information

NPI: 1275851487
Provider Name (Legal Business Name): NICK M NGUYEN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 WILLOW ST STE 200
SAN JOSE CA
95125-5112
US

IV. Provider business mailing address

1645 WILLOW ST STE 200
SAN JOSE CA
95125-5112
US

V. Phone/Fax

Practice location:
  • Phone: 408-293-6570
  • Fax: 408-293-6628
Mailing address:
  • Phone: 408-293-6570
  • Fax: 408-293-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number44520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: