Provider Demographics
NPI:1619065653
Name:DUONG, BICH - HAI THI (DDS)
Entity Type:Individual
Prefix:MRS
First Name:BICH - HAI
Middle Name:THI
Last Name:DUONG
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 1:29 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2022
Mailing Address - Country:US
Mailing Address - Phone:408-286-3240
Mailing Address - Fax:408-292-2956
Practice Address - Street 1:29 S 13TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2022
Practice Address - Country:US
Practice Address - Phone:408-286-3240
Practice Address - Fax:408-292-2956
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice