Provider Demographics
NPI:1700057429
Name:NGUYEN, TU QUYNH (DDS)
Entity type:Individual
Prefix:MS
First Name:TU
Middle Name:QUYNH
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 1:6804 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2312
Mailing Address - Country:US
Mailing Address - Phone:773-586-3366
Mailing Address - Fax:773-586-9554
Practice Address - Street 1:6804 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2312
Practice Address - Country:US
Practice Address - Phone:773-586-3366
Practice Address - Fax:773-586-9554
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0190258191223G0001X
CA49617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice