Provider Demographics
NPI:1023229747
Name:CHIC DENTAL CARE
Entity type:Organization
Organization Name:CHIC DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-362-9622
Mailing Address - Street 1:5278 MONTEREY HWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-4268
Mailing Address - Country:US
Mailing Address - Phone:408-362-9622
Mailing Address - Fax:408-362-9633
Practice Address - Street 1:5278 MONTEREY HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-4268
Practice Address - Country:US
Practice Address - Phone:408-362-9622
Practice Address - Fax:408-362-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB47143-01OtherHEALTHY FAMILY
CAG92526-01OtherDENTI-CAL