Provider Demographics
NPI:1245655232
Name:PHUONGHA NGUYEN DDS INC
Entity type:Organization
Organization Name:PHUONGHA NGUYEN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHUONGHA
Authorized Official - Middle Name:LE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-264-1471
Mailing Address - Street 1:2390 ALMADEN RD STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2142
Mailing Address - Country:US
Mailing Address - Phone:408-264-1471
Mailing Address - Fax:408-264-1581
Practice Address - Street 1:2390 ALMADEN RD STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2142
Practice Address - Country:US
Practice Address - Phone:408-264-1471
Practice Address - Fax:408-264-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty