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General NPI Number Information
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NPI Number | 1568113660
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Entity Type | Organization
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Legal Business Name | THACHTU LE NGUYEN DDS INC
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 2593 S KING RD
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City | SAN JOSE
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State | CA
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Zip | 95122-1880
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Country | US
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Telephone | 408-238-4824
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Fax | 408-238-3028
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Provider Business Mailing Address
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Address Line | 2593 S KING RD
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City | SAN JOSE
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State | CA
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Zip | 95122-1880
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Country | US
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Telephone | 408-238-4824
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THACHTU LE NGUYEN
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Credential | DDS
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Telephone | 408-509-8655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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