Provider Demographics
NPI:1649035387
Name:TAN KHUU DENTAL CORPORATION
Entity type:Organization
Organization Name:TAN KHUU DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAN
Authorized Official - Middle Name:NHAT
Authorized Official - Last Name:KHUU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-910-5008
Mailing Address - Street 1:252 SIENA
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7635
Mailing Address - Country:US
Mailing Address - Phone:949-910-5008
Mailing Address - Fax:
Practice Address - Street 1:10272 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4830
Practice Address - Country:US
Practice Address - Phone:949-988-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental