Provider Demographics
NPI:1215059696
Name:NGUYEN, JACQUELINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:B
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5655 SILVER CREEK VALLEY RD # 749
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2473
Mailing Address - Country:US
Mailing Address - Phone:408-475-8805
Mailing Address - Fax:
Practice Address - Street 1:826 E FREMONT AVE STE D
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3650
Practice Address - Country:US
Practice Address - Phone:669-272-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist