Healthcare Provider Details

I. General information

NPI: 1063651784
Provider Name (Legal Business Name): HUONG T NGUYEN, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N. JACKSON AVENUE SUITE 102
SAN JOSE CA
95116-1917
US

IV. Provider business mailing address

135 N. JACKSON AVENUE SUITE 102
SAN JOSE CA
95116-1917
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-2207
  • Fax: 408-258-2207
Mailing address:
  • Phone: 408-258-2207
  • Fax: 408-258-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number48650
License Number StateCA

VIII. Authorized Official

Name: MRS. HUONG THIEN NGUYEN
Title or Position: CEO
Credential: D.D.S
Phone: 408-258-2207