Provider Demographics
NPI:1174675870
Name:NGUYEN, KY-CUONG NHU (DDS)
Entity type:Individual
Prefix:DR
First Name:KY-CUONG
Middle Name:NHU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 HISTORICAL PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5064
Mailing Address - Country:US
Mailing Address - Phone:209-825-3266
Mailing Address - Fax:209-825-3277
Practice Address - Street 1:1333 HISTORICAL PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5064
Practice Address - Country:US
Practice Address - Phone:209-825-3266
Practice Address - Fax:209-825-3277
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice