Provider Demographics
NPI:1467642348
Name:NGUYEN, JOHNNY KIM (DDS)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:KIM
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 1:4102 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3521
Mailing Address - Country:US
Mailing Address - Phone:832-620-5630
Mailing Address - Fax:
Practice Address - Street 1:11595 S WILCREST DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4700
Practice Address - Country:US
Practice Address - Phone:281-982-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice