Provider Demographics
NPI:1093906596
Name:NGUYEN, KATHERINE THAM
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:THAM
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 1:17435 SW FARMINGTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3234
Mailing Address - Country:US
Mailing Address - Phone:503-649-1700
Mailing Address - Fax:503-649-1712
Practice Address - Street 1:17435 SW FARMINGTON RD
Practice Address - Street 2:STE D
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-3234
Practice Address - Country:US
Practice Address - Phone:503-888-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice