Provider Demographics
NPI:1194303115
Name:KY NGUYEN DDS INC
Entity type:Organization
Organization Name:KY NGUYEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-223-9228
Mailing Address - Street 1:4055 EVERGREEN VILLAGE SQ STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1750
Mailing Address - Country:US
Mailing Address - Phone:408-223-9228
Mailing Address - Fax:
Practice Address - Street 1:4055 EVERGREEN VILLAGE SQ STE 240
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1750
Practice Address - Country:US
Practice Address - Phone:408-223-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental