Healthcare Provider Details

I. General information

NPI: 1912391707
Provider Name (Legal Business Name): DAVID NGUYEN BSDH, EPDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 SE 127TH AVE
PORTLAND OR
97233-1274
US

IV. Provider business mailing address

1565 SE 127TH AVE
PORTLAND OR
97233-1274
US

V. Phone/Fax

Practice location:
  • Phone: 209-298-1768
  • Fax:
Mailing address:
  • Phone: 209-298-1768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberH6818
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6818
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: