Provider Demographics
NPI:1477609964
Name:VU, JENNIFER NGUYEN (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NGUYEN
Last Name:VU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:THU HUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12940 FOOTHILL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-837-4433
Mailing Address - Fax:818-837-6644
Practice Address - Street 1:12940 FOOTHILL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-837-4433
Practice Address - Fax:818-837-6644
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4442601OtherDENTICAL