Provider Demographics
NPI:1306963418
Name:NGUYEN, HUNG T (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:HUNG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:FRANK HUNG
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MSD
Mailing Address - Street 1:1142 JACKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3700
Mailing Address - Country:US
Mailing Address - Phone:408-945-0772
Mailing Address - Fax:
Practice Address - Street 1:1142 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3700
Practice Address - Country:US
Practice Address - Phone:408-945-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41292OtherCA DENTAL LICENSE NUMBER
CA515814Medicare ID - Type UnspecifiedPROVIDER NUMBER