Provider Demographics
NPI:1437292604
Name:NGUYEN, TOAN KHANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOAN
Middle Name:KHANH
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 1:120 CURRY AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2516
Mailing Address - Country:US
Mailing Address - Phone:408-782-5008
Mailing Address - Fax:
Practice Address - Street 1:1672 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1235
Practice Address - Country:US
Practice Address - Phone:408-272-3999
Practice Address - Fax:408-272-2202
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41291Medicaid