Provider Demographics
NPI:1508502071
Name:KHUU, SANDRA (DMD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KHUU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 58TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2026
Mailing Address - Country:US
Mailing Address - Phone:781-975-1823
Mailing Address - Fax:
Practice Address - Street 1:3214 58TH ST APT 3
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2026
Practice Address - Country:US
Practice Address - Phone:781-975-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist