=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922781806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TSUI NGUYEN DENTAL PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2023
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38062 MARTHA AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-556-3776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38062 MARTHA AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PART OWNER
-----------------------------------------------------
Name | DR. NGHIA HUU NGUYEN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 510-585-3456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------