Provider Demographics
NPI:1295960599
Name:NGUYEN, TU KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:TU
Middle Name:KIM
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 1:5319 RIVER LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0713
Mailing Address - Country:US
Mailing Address - Phone:817-793-8102
Mailing Address - Fax:
Practice Address - Street 1:6302 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-5121
Practice Address - Country:US
Practice Address - Phone:817-446-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice