Provider Demographics
NPI:1275654394
Name:HYLAND, TUONG-VAN
Entity Type:Individual
Prefix:
First Name:TUONG-VAN
Middle Name:
Last Name:HYLAND
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 1:500 ALFRED NOBEL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1840
Mailing Address - Country:US
Mailing Address - Phone:510-741-2140
Mailing Address - Fax:510-741-2142
Practice Address - Street 1:500 ALFRED NOBEL DR STE 240
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1840
Practice Address - Country:US
Practice Address - Phone:510-741-2140
Practice Address - Fax:510-741-2142
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist