Provider Demographics
NPI:1154488757
Name:NGUYEN, LONG (DDS)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:NGUYEN
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 1:2593 S KING RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1880
Mailing Address - Country:US
Mailing Address - Phone:408-270-5384
Mailing Address - Fax:408-270-7799
Practice Address - Street 1:2593 S KING RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1880
Practice Address - Country:US
Practice Address - Phone:408-270-5384
Practice Address - Fax:408-270-7799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93851OtherDENTI-CAL