Provider Demographics
NPI:1285199216
Name:AMY KIM NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:AMY KIM NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-606-7978
Mailing Address - Street 1:2531 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3812
Mailing Address - Country:US
Mailing Address - Phone:650-880-1550
Mailing Address - Fax:650-880-1551
Practice Address - Street 1:2531 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3812
Practice Address - Country:US
Practice Address - Phone:650-880-1550
Practice Address - Fax:650-880-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental