Provider Demographics
NPI:1073904744
Name:NGUYEN, KHANH (DDS)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:
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 1:2567 W LAKE VAN NESS CIR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-7023
Mailing Address - Country:US
Mailing Address - Phone:559-273-3375
Mailing Address - Fax:559-251-7190
Practice Address - Street 1:2567 W LAKE VAN NESS CIR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7023
Practice Address - Country:US
Practice Address - Phone:559-273-3375
Practice Address - Fax:559-251-7190
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist