Provider Demographics
NPI:1154831931
Name:NGUYEN, KEVIN KIEN TRUNG (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN KIEN
Middle Name:TRUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 RILEY WAY LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6715
Mailing Address - Country:US
Mailing Address - Phone:832-630-2077
Mailing Address - Fax:
Practice Address - Street 1:1249 W BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-3832
Practice Address - Country:US
Practice Address - Phone:832-630-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice