Provider Demographics
NPI:1215924287
Name:HA, HIEN NGUYEN (DMD)
Entity type:Individual
Prefix:DR
First Name:HIEN
Middle Name:NGUYEN
Last Name:HA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 CHERRY AVE APT 275
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2743
Mailing Address - Country:US
Mailing Address - Phone:408-396-2986
Mailing Address - Fax:
Practice Address - Street 1:992 STORY RD STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2674
Practice Address - Country:US
Practice Address - Phone:408-885-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice