Provider Demographics
NPI:1053319707
Name:NGUYEN, PAULINE PHUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5278 MONTEREY HWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-4268
Mailing Address - Country:US
Mailing Address - Phone:408-362-9622
Mailing Address - Fax:408-362-9633
Practice Address - Street 1:5278 MONTEREY HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-4268
Practice Address - Country:US
Practice Address - Phone:408-362-9622
Practice Address - Fax:408-362-9633
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB47143-01OtherDELTA DENTAL STATE GOV PR
CAG92526-01OtherDENTI-CAL