Healthcare Provider Details

I. General information

NPI: 1346313368
Provider Name (Legal Business Name): THIEN T. NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 S UNION AVE
TACOMA WA
98409-4528
US

IV. Provider business mailing address

4545 S UNION AVE
TACOMA WA
98409-4528
US

V. Phone/Fax

Practice location:
  • Phone: 253-475-7500
  • Fax: 253-475-9115
Mailing address:
  • Phone: 253-475-7500
  • Fax: 253-475-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00008444
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: