Provider Demographics
NPI:1265708358
Name:QUY LAM NGUYEN DDS INC
Entity type:Organization
Organization Name:QUY LAM NGUYEN DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUY LAM
Authorized Official - Middle Name:PHUOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-757-9171
Mailing Address - Street 1:11863 SPRUCE RUN DR APT C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-4746
Mailing Address - Country:US
Mailing Address - Phone:619-584-4015
Mailing Address - Fax:619-584-4016
Practice Address - Street 1:8963 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2716
Practice Address - Country:US
Practice Address - Phone:858-757-9171
Practice Address - Fax:833-623-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty