Provider Demographics
NPI:1225184237
Name:NGUYEN, AMY M
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
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 1:699 LEWELLING BLVD
Mailing Address - Street 2:SUITE 286
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1870
Mailing Address - Country:US
Mailing Address - Phone:510-825-6091
Mailing Address - Fax:
Practice Address - Street 1:699 LEWELLING BLVD
Practice Address - Street 2:SUITE 286
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1870
Practice Address - Country:US
Practice Address - Phone:510-825-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist