Provider Demographics
NPI:1346500238
Name:UYEN THOMPSON DDS INC
Entity Type:Organization
Organization Name:UYEN THOMPSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:UYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-756-2321
Mailing Address - Street 1:688 OLD TELEGRAPH CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6587
Mailing Address - Country:US
Mailing Address - Phone:619-216-2121
Mailing Address - Fax:619-216-2122
Practice Address - Street 1:688 OLD TELEGRAPH CANYON RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6587
Practice Address - Country:US
Practice Address - Phone:619-216-2121
Practice Address - Fax:619-216-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57353261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental