Provider Demographics
NPI:1063714194
Name:LISA PHUONG-THUY NGUYEN, DDS CORPORATION
Entity type:Organization
Organization Name:LISA PHUONG-THUY NGUYEN, DDS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:PT
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-462-9135
Mailing Address - Street 1:990 W FREMONT AVE STE X
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3065
Mailing Address - Country:US
Mailing Address - Phone:408-462-9135
Mailing Address - Fax:
Practice Address - Street 1:990 W FREMONT AVE STE X
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3065
Practice Address - Country:US
Practice Address - Phone:408-462-9135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty