Provider Demographics
NPI:1700351236
Name:MENDOZA, J ALEXANDER HOANG
Entity Type:Individual
Prefix:
First Name:J ALEXANDER
Middle Name:HOANG
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 MORSE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2119
Mailing Address - Country:US
Mailing Address - Phone:408-799-8548
Mailing Address - Fax:
Practice Address - Street 1:90 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5002
Practice Address - Country:US
Practice Address - Phone:408-294-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist