Provider Demographics
NPI:1508998501
Name:NGUYEN, TUONG HUU (DDS)
Entity Type:Individual
Prefix:DR
First Name:TUONG
Middle Name:HUU
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 1:125 N JACKSON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1915
Mailing Address - Country:US
Mailing Address - Phone:408-923-8272
Mailing Address - Fax:408-923-8211
Practice Address - Street 1:125 N JACKSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1915
Practice Address - Country:US
Practice Address - Phone:408-923-8272
Practice Address - Fax:408-923-8211
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 404781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 90892-01Medicaid