Organization
SAN JOSE DENTAL SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHAM NGUYEN DDS (VICE PRESIDENT)
(408) 240-9000
Entity
Organization
Contact information
Practice address
2048 STORY RD, SAN JOSE, CA 95122-1668
(408) 240-9000
Mailing address
2048 STORY RD, SAN JOSE, CA 95122-1668
(408) 240-9000
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
D52747
CA
261QD0000X
Dental Clinic/Center
D52747
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D52747
DENTI-CAL LICENSE NUMBER
CA
Enumeration date
11/09/2007
Last updated
04/05/2025
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