Provider Demographics
NPI:1538136569
Name:NGUYEN, THUAN THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:THUAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:THUAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1692 TULLY RD
Mailing Address - Street 2:STE 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2549
Mailing Address - Country:US
Mailing Address - Phone:206-203-0588
Mailing Address - Fax:
Practice Address - Street 1:1692 TULLY RD
Practice Address - Street 2:STE 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2549
Practice Address - Country:US
Practice Address - Phone:206-203-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33820OtherCA LICENSE