Provider Demographics
NPI:1174771893
Name:NGUYEN, HOA THI KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:HOA
Middle Name:THI KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17205 STRATHERN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1020
Mailing Address - Country:US
Mailing Address - Phone:818-621-3464
Mailing Address - Fax:
Practice Address - Street 1:17205 STRATHERN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1020
Practice Address - Country:US
Practice Address - Phone:818-621-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist