Provider Demographics
NPI:1295192862
Name:NGUYEN, MICHAEL NGOC (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24703 AMADOR ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1832
Mailing Address - Country:US
Mailing Address - Phone:510-785-0999
Mailing Address - Fax:
Practice Address - Street 1:24703 AMADOR ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1832
Practice Address - Country:US
Practice Address - Phone:510-785-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice