Provider Demographics
NPI:1194454678
Name:NGUYENPHUC, JOUJOU DI-SON (DDS)
Entity type:Individual
Prefix:
First Name:JOUJOU
Middle Name:DI-SON
Last Name:NGUYENPHUC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DI-SON
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3927 PINE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4185
Mailing Address - Country:US
Mailing Address - Phone:213-545-6707
Mailing Address - Fax:
Practice Address - Street 1:1565 HOLLENBECK AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-5922
Practice Address - Country:US
Practice Address - Phone:408-774-9198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
PADS0445361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program