Provider Demographics
NPI:1073144671
Name:NGUYEN, MICHELLE YEN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15394 SE IVY CREEK ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4459
Mailing Address - Country:US
Mailing Address - Phone:971-222-5451
Mailing Address - Fax:
Practice Address - Street 1:15280 SE BARON LOOP
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4468
Practice Address - Country:US
Practice Address - Phone:971-222-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5768124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist