Provider Demographics
NPI:1790836161
Name:NGUYEN, PHU HUU (DDSR)
Entity Type:Individual
Prefix:DR
First Name:PHU
Middle Name:HUU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14282 BROOKHURST ST
Mailing Address - Street 2:SUIT #6
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4663
Mailing Address - Country:US
Mailing Address - Phone:714-531-6487
Mailing Address - Fax:714-531-6487
Practice Address - Street 1:14282 BROOKHURST ST
Practice Address - Street 2:SUIT #6
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4663
Practice Address - Country:US
Practice Address - Phone:714-531-6487
Practice Address - Fax:714-531-6487
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4422501OtherDENTI-CAL