Provider Demographics
NPI:1609009729
Name:NGUYEN, BAOCHI DANG (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:BAOCHI
Middle Name:DANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10267 IZZY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1605
Mailing Address - Country:US
Mailing Address - Phone:916-837-9887
Mailing Address - Fax:916-714-6062
Practice Address - Street 1:10267 IZZY WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1605
Practice Address - Country:US
Practice Address - Phone:916-837-9887
Practice Address - Fax:916-714-6062
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA266OtherRDHAP
CA18289OtherRDH