Provider Demographics
NPI:1770678047
Name:PHAN, TU QUYNH K (DDS)
Entity type:Individual
Prefix:DR
First Name:TU QUYNH
Middle Name:K
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:QUYNH
Other - Middle Name:K
Other - Last Name:ABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:485 SOUTH DR
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4202
Mailing Address - Country:US
Mailing Address - Phone:650-961-4492
Mailing Address - Fax:650-745-4144
Practice Address - Street 1:485 SOUTH DR
Practice Address - Street 2:STE A
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4202
Practice Address - Country:US
Practice Address - Phone:650-961-4492
Practice Address - Fax:650-745-4144
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist