Provider Demographics
NPI:1568113660
Name:THACHTU LE NGUYEN DDS INC
Entity Type:Organization
Organization Name:THACHTU LE NGUYEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THACHTU
Authorized Official - Middle Name:LE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-509-8655
Mailing Address - Street 1:2593 S KING RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1880
Mailing Address - Country:US
Mailing Address - Phone:408-238-4824
Mailing Address - Fax:
Practice Address - Street 1:2593 S KING RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1880
Practice Address - Country:US
Practice Address - Phone:408-238-4824
Practice Address - Fax:408-238-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental