Provider Demographics
NPI:1336415504
Name:AMY K, NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:AMY K, NGUYEN, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-606-7978
Mailing Address - Street 1:1429 GRANT RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3250
Mailing Address - Country:US
Mailing Address - Phone:650-967-9900
Mailing Address - Fax:650-967-9909
Practice Address - Street 1:1429 GRANT RD.
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3250
Practice Address - Country:US
Practice Address - Phone:650-967-9900
Practice Address - Fax:650-967-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty