Provider Demographics
NPI:1124332796
Name:NGUYEN, KEVIN HUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75161-7402
Mailing Address - Country:US
Mailing Address - Phone:972-948-9483
Mailing Address - Fax:
Practice Address - Street 1:536 S FM 156
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-4600
Practice Address - Country:US
Practice Address - Phone:972-948-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0025567122300000X
TX255671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist