Provider Demographics
NPI:1629123633
Name:NGUYEN, HOANG HUY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:HUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 MIRA MESA BLVD
Mailing Address - Street 2:STE. 218
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4820
Mailing Address - Country:US
Mailing Address - Phone:858-689-9295
Mailing Address - Fax:858-689-9301
Practice Address - Street 1:9225 MIRA MESA BLVD
Practice Address - Street 2:STE. 218
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4820
Practice Address - Country:US
Practice Address - Phone:858-689-9295
Practice Address - Fax:858-689-9301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39455OtherSTATE LICENSE NUMBER
CAB39455-01Medicaid