Provider Demographics
NPI:1659699627
Name:NGUYEN, JEFFREY VU (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:VU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 BARRANCA PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4687
Mailing Address - Country:US
Mailing Address - Phone:949-679-3470
Mailing Address - Fax:
Practice Address - Street 1:4950 BARRANCA PKWY STE 202
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4687
Practice Address - Country:US
Practice Address - Phone:949-679-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142522204E00000X, 204E00000X
CADDS1000521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery