Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 60044 | CA |
NPI | 1043566813 |
---|---|
Provider Name | Dr. Michael Nguyen |
First Address | San Jose, CA 95111-3616 |
Second Address | San Jose, CA 95111-3616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 31/07/2012 |