Provider Demographics
NPI:1275049751
Name:TUAN HOANG NGUYEN DDS INC.
Entity Type:Organization
Organization Name:TUAN HOANG NGUYEN DDS INC.
Other - Org Name:TM NORTH VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-254-4567
Mailing Address - Street 1:2470 BERRYESSA RD STE I
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1309
Mailing Address - Country:US
Mailing Address - Phone:408-254-4567
Mailing Address - Fax:408-254-3567
Practice Address - Street 1:2470 BERRYESSA RD STE I
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1309
Practice Address - Country:US
Practice Address - Phone:408-254-4567
Practice Address - Fax:408-254-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB48756-01Medicaid