1497501803 NPI number — QUYNH ANH TRUONG NGUYEN DDS

Table of content: QUYNH ANH TRUONG NGUYEN DDS (NPI 1497501803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497501803 NPI number — QUYNH ANH TRUONG NGUYEN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
QUYNH ANH
Provider Middle Name:
TRUONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497501803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 UNIVERSITY OF NEW MEXICO
Provider Second Line Business Mailing Address:
MSC06 3500
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-925-4031
Provider Business Mailing Address Fax Number:
505-925-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 UNIVERSITY OF NEW MEXICO
Provider Second Line Business Practice Location Address:
MSC06 3500
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-925-4031
Provider Business Practice Location Address Fax Number:
505-925-4030
Provider Enumeration Date:
04/26/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)