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General NPI Number Information
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NPI Number | 1194454678
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Entity Type | Individual
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Provider Name | JOUJOU DI-SON NGUYENPHUC DDS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1565 HOLLENBECK AVE
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City | SUNNYVALE
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State | CA
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Zip | 94087-5922
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Country | US
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Telephone | 408-774-9198
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Fax |
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Provider Business Mailing Address
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Address Line | 3927 PINE ST APT 102
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4185
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Country | US
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Telephone | 213-545-6707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS044536
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License Number State | PA
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