Provider Demographics
NPI:1639297039
Name:NGUYEN, DIEM-TRANG DOAN (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:DIEM-TRANG
Middle Name:DOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2336
Mailing Address - Country:US
Mailing Address - Phone:914-237-0300
Mailing Address - Fax:
Practice Address - Street 1:453 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2336
Practice Address - Country:US
Practice Address - Phone:914-237-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044033-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice