Provider Demographics
NPI:1689890154
Name:NGUYEN, JENNY YEN PHI (DMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:YEN PHI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:YEN PHI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:14350 SW BARROWS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2019
Mailing Address - Country:US
Mailing Address - Phone:503-521-1818
Mailing Address - Fax:503-524-0661
Practice Address - Street 1:14350 SW BARROWS RD STE 4
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2019
Practice Address - Country:US
Practice Address - Phone:503-521-1818
Practice Address - Fax:503-524-0661
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD70961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice