Provider Demographics
NPI:1013146034
Name:NGUYEN, DUNG NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUNG
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STEPHANI
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:90 E TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5002
Mailing Address - Country:US
Mailing Address - Phone:408-294-9944
Mailing Address - Fax:408-294-8260
Practice Address - Street 1:90 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5002
Practice Address - Country:US
Practice Address - Phone:408-294-9944
Practice Address - Fax:408-294-8260
Is Sole Proprietor?:No
Enumeration Date:2009-07-12
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice