Provider Demographics
NPI:1003024415
Name:NGUYEN, HUONG THI MAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUONG THI
Middle Name:MAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 MCKEE RD STE 40
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1209
Mailing Address - Country:US
Mailing Address - Phone:408-937-9229
Mailing Address - Fax:408-937-6169
Practice Address - Street 1:1657 MCKEE RD STE 40
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1209
Practice Address - Country:US
Practice Address - Phone:408-937-9229
Practice Address - Fax:408-937-6169
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice