Provider Demographics
NPI:1174128052
Name:NGUYEN, NGHIA HUU (DMD)
Entity type:Individual
Prefix:DR
First Name:NGHIA
Middle Name:HUU
Last Name:NGUYEN
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 1:4002 CORALLINE CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3318
Mailing Address - Country:US
Mailing Address - Phone:510-585-3456
Mailing Address - Fax:
Practice Address - Street 1:221 FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3603
Practice Address - Country:US
Practice Address - Phone:415-388-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist