Individual
DR. KEVIN T NGUYEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3280 NE BROADWAY ST, PORTLAND, OR 97232-1815
(503) 282-0521
Mailing address
3280 NE BROADWAY ST, PORTLAND, OR 97232-1815
(503) 282-0521
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DE61178185
WA
1223G0001X
General Practice Dentistry
Primary
D12013
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WDL7PPTD663B
DRIVER LICENSE
WA
Enumeration date
08/30/2021
Last updated
07/31/2024
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