Provider Demographics
NPI:1598077208
Name:TU V. HUYNH DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:TU V. HUYNH DDS DENTAL CORPORATION
Other - Org Name:NOVA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TU
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-535-0998
Mailing Address - Street 1:111 S BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2407
Mailing Address - Country:US
Mailing Address - Phone:714-535-0998
Mailing Address - Fax:714-535-1065
Practice Address - Street 1:303 N EAST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3341
Practice Address - Country:US
Practice Address - Phone:714-635-0800
Practice Address - Fax:714-635-0811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TU V. HUYNH DDS DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD486151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9351001Medicaid
CA1073682654OtherNPPES
CA1639305451OtherNPPES