Healthcare Provider Details

I. General information

NPI: 1528238615
Provider Name (Legal Business Name): TUYEN QUANG NGUYEN D.D.S , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 E SANTA CLARA ST
SAN JOSE CA
95112-1902
US

IV. Provider business mailing address

634 E SANTA CLARA ST
SAN JOSE CA
95112-1902
US

V. Phone/Fax

Practice location:
  • Phone: 408-286-6156
  • Fax: 408-286-6156
Mailing address:
  • Phone: 408-286-6156
  • Fax: 408-286-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number45940
License Number StateCA

VIII. Authorized Official

Name: DR. TUYEN QUANG NGUYEN
Title or Position: DENTIST
Credential: D.D.S
Phone: 408-286-6156