Provider Demographics
NPI:1750399606
Name:VAN, LINH NGOC (DDS)
Entity type:Individual
Prefix:DR
First Name:LINH
Middle Name:NGOC
Last Name:VAN
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 1:3330 MICHELANGELO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1749
Mailing Address - Country:US
Mailing Address - Phone:415-902-0226
Mailing Address - Fax:408-521-0722
Practice Address - Street 1:1667 DOMINICAN WAY
Practice Address - Street 2:SUITE 232
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1518
Practice Address - Country:US
Practice Address - Phone:831-476-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry