Provider Demographics
NPI:1053497339
Name:VU, SUONG NGUYEN (D D S)
Entity Type:Individual
Prefix:
First Name:SUONG
Middle Name:NGUYEN
Last Name:VU
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:DR
Other - First Name:SUONG
Other - Middle Name:THI NGOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:14265 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4648
Mailing Address - Country:US
Mailing Address - Phone:714-531-2773
Mailing Address - Fax:
Practice Address - Street 1:14265 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4648
Practice Address - Country:US
Practice Address - Phone:714-531-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist