Provider Demographics
NPI:1609010735
Name:SOUTH BAY ENDODONTICS
Entity Type:Organization
Organization Name:SOUTH BAY ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:HUYNH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-421-3374
Mailing Address - Street 1:885 CANARIOS CT
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7877
Mailing Address - Country:US
Mailing Address - Phone:619-421-3374
Mailing Address - Fax:619-421-3410
Practice Address - Street 1:885 CANARIOS CT
Practice Address - Street 2:SUITE 208
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7877
Practice Address - Country:US
Practice Address - Phone:619-421-3374
Practice Address - Fax:619-421-3410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA JOLLA DENTAL SPECIALTY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty