Provider Demographics
NPI:1558457473
Name:VAN, HUAN (DMD)
Entity type:Individual
Prefix:DR
First Name:HUAN
Middle Name:
Last Name:VAN
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 1:5202 SILVER ACRES CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2102
Mailing Address - Country:US
Mailing Address - Phone:408-449-2812
Mailing Address - Fax:
Practice Address - Street 1:5202 SILVER ACRES CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-2102
Practice Address - Country:US
Practice Address - Phone:408-256-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice