Provider Demographics
NPI:1457923252
Name:NGUYEN, KHA VU NGUYEN (DDS)
Entity type:Individual
Prefix:
First Name:KHA VU NGUYEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KHA
Other - Middle Name:V
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:17202 AURORA AVE N APT 525
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5359
Mailing Address - Country:US
Mailing Address - Phone:253-282-3990
Mailing Address - Fax:
Practice Address - Street 1:4311 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4011
Practice Address - Country:US
Practice Address - Phone:425-235-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61179107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist