Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 50337 | CA |
NPI | 1003004920 |
---|---|
Provider Name | Nam Hoai Nguyen |
First Address | San Jose, CA 95127-3025 |
Second Address | San Jose, CA 95127-3025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 04/10/2007 |