Provider Demographics
NPI:1588616197
Name:NGUYEN, CHI QUYNH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:QUYNH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 BERRYESSA RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2925
Mailing Address - Country:US
Mailing Address - Phone:408-251-6559
Mailing Address - Fax:
Practice Address - Street 1:2664 BERRYESSA RD
Practice Address - Street 2:STE 103
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2925
Practice Address - Country:US
Practice Address - Phone:408-251-6559
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54112Medicare ID - Type Unspecified