Provider Demographics
NPI:1942721618
Name:NGUYEN, KHANH VY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:VY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 AVENIR PL APT 2324
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7490
Mailing Address - Country:US
Mailing Address - Phone:703-853-6019
Mailing Address - Fax:
Practice Address - Street 1:42395 RYAN RD STE 104
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-4864
Practice Address - Country:US
Practice Address - Phone:703-542-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014157571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice