Provider Demographics
NPI:1124411228
Name:NGUYEN, CHAULONG THI (DDS MAGD)
Entity Type:Individual
Prefix:DR
First Name:CHAULONG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 OAK GROVE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4362
Mailing Address - Country:US
Mailing Address - Phone:650-838-0260
Mailing Address - Fax:650-433-5054
Practice Address - Street 1:724 OAK GROVE AVE STE 120
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4362
Practice Address - Country:US
Practice Address - Phone:650-838-0260
Practice Address - Fax:650-433-5054
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice