Provider Demographics
NPI:1255665295
Name:NGUYEN, KHUYEN TINA (DMD)
Entity Type:Individual
Prefix:
First Name:KHUYEN
Middle Name:TINA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 SW MURRAY SCHOLLS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9277
Mailing Address - Country:US
Mailing Address - Phone:503-521-1333
Mailing Address - Fax:503-524-9777
Practice Address - Street 1:14500 SW MURRAY SCHOLLS DR STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9277
Practice Address - Country:US
Practice Address - Phone:503-521-1333
Practice Address - Fax:503-524-9777
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD093101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice