Provider Demographics
NPI:1073682654
Name:TU V HUYNH DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:TU V HUYNH DDS DENTAL CORPORATION
Other - Org Name:NOVA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:TU
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-535-0998
Mailing Address - Street 1:111 S BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-535-0998
Mailing Address - Fax:714-535-1065
Practice Address - Street 1:111 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-535-0998
Practice Address - Fax:714-535-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA48615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93510Medicaid