Healthcare Provider Details

I. General information

NPI: 1295653988
Provider Name (Legal Business Name): KAYLAN NGUYEN HA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 EDGEWATER ST NW
SALEM OR
97304-4050
US

IV. Provider business mailing address

1974 LINWOOD ST NW APT 1034
SALEM OR
97304-2397
US

V. Phone/Fax

Practice location:
  • Phone: 503-378-0466
  • Fax:
Mailing address:
  • Phone: 808-258-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12388
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: