Provider Demographics
NPI:1710192299
Name:NGUYEN, TRUONG XUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRUONG
Middle Name:XUAN
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 1:933 C ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5122
Mailing Address - Country:US
Mailing Address - Phone:510-940-0200
Mailing Address - Fax:
Practice Address - Street 1:933 C ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5122
Practice Address - Country:US
Practice Address - Phone:510-940-0200
Practice Address - Fax:510-940-0203
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522-317Medicare UPIN
CAG93189-01Medicare ID - Type Unspecified