Provider Demographics
NPI:1659487254
Name:NGUYEN, HIEN PHUC BAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIEN
Middle Name:PHUC BAO
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 1:314 PALOMAR ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3111
Mailing Address - Country:US
Mailing Address - Phone:619-498-3888
Mailing Address - Fax:619-498-4848
Practice Address - Street 1:314 PALOMAR ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3111
Practice Address - Country:US
Practice Address - Phone:619-498-3888
Practice Address - Fax:619-498-4848
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93315-01OtherDENTI-CAL
CAB50656-01OtherHEALTHY FAMILY DELTA DENT