Healthcare Provider Details

I. General information

NPI: 1114838224
Provider Name (Legal Business Name): XUAN HUY V NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 MONTEREY RD
SAN JOSE CA
95138-1529
US

IV. Provider business mailing address

5133 VERA LN
SAN JOSE CA
95111-4067
US

V. Phone/Fax

Practice location:
  • Phone: 301-655-2419
  • Fax:
Mailing address:
  • Phone: 301-655-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number34643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: