Provider Demographics
NPI:1235635418
Name:NGUYEN, KELLY KIM (DDS)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:KIM
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 1:337 E LELAND RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4911
Mailing Address - Country:US
Mailing Address - Phone:925-431-1250
Mailing Address - Fax:
Practice Address - Street 1:339 E LELAND RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4911
Practice Address - Country:US
Practice Address - Phone:925-431-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist