Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS040485 | PA |
NPI | 1053797456 |
---|---|
Provider Name | Cuong Quoc Nguyen |
First Address | Philadelphia, PA 19144-4248 |
Second Address | Philadelphia, PA 19123-1957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2015 |
Last Update Date | 07/08/2015 |