Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 42749 | CA |
NPI | 1013075324 |
---|---|
Provider Name | Dr. Dun G Thi Phuong Nguyen |
First Address | San Diego, CA 92104-2201 |
Second Address | San Diego, CA 92104-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |