Provider Demographics
NPI:1043222110
Name:NGUYEN, THU XUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:XUAN
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 1:647 S BERNARDO AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1020
Mailing Address - Country:US
Mailing Address - Phone:408-735-7535
Mailing Address - Fax:408-735-7536
Practice Address - Street 1:647 S BERNARDO AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1020
Practice Address - Country:US
Practice Address - Phone:408-735-7535
Practice Address - Fax:408-735-7536
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42940OtherMEDI-CAL