Provider Demographics
NPI:1639516982
Name:NGUYEN, KHOA PHUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:KHOA
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E ARQUES AVE # 171
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4531
Mailing Address - Country:US
Mailing Address - Phone:408-400-3133
Mailing Address - Fax:408-400-3134
Practice Address - Street 1:927 E ARQUES AVE # 171
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085
Practice Address - Country:US
Practice Address - Phone:408-400-3133
Practice Address - Fax:408-400-3134
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1007671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice