Organization
1692 TULLY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHUNG KIM NGUYEN (DENTIST)
(408) 279-2114
Entity
Organization
Contact information
Practice address
2114 SENIOR ROAD, SUITE 25, SAN JOSE, CA 95112
(408) 279-2114
(408) 279-1828
Mailing address
1692 TULLY ROAD, #4, SAN JOSE, CA 95122
(408) 223-6953
(408) 223-0749
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
44749
CA
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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