Provider Demographics
NPI:1447974001
Name:NGUYEN, THU HUU BAO (DMD)
Entity type:Individual
Prefix:
First Name:THU
Middle Name:HUU BAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12651 WILLOWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4244
Mailing Address - Country:US
Mailing Address - Phone:657-244-6533
Mailing Address - Fax:
Practice Address - Street 1:12651 WILLOWOOD AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4244
Practice Address - Country:US
Practice Address - Phone:657-244-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1081671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice