Basic Information
| Provider Information | |||||||||
| NPI: | 1467052639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | DANG KHOA | ||||||||
| MiddleName: | TRINH | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23680 NE HOLLADAY ST | ||||||||
| Address2: | |||||||||
| City: | WOOD VILLAGE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970602764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034323960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4925 SW GRIFFITH DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970052923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554336825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2020 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D11318 | OR | Y | Dental Providers | Dentist | General Practice |
No ID Information.