1692 Tully Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

44749 Issued in CA

Legal business name

1692 TULLY DENTISTRY

Practice address

2114 Senior Road
Suite 25
San Jose, CA 95112

Phone

(408) 279-2114

Fax

(408) 279-1828

NPI assigned

Jun 10, 2009

Last updated

Jun 10, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Phung Kim NguyenNPI 1891714754

Title

Dentist

Phone

(408) 279-2114

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phung Kim Nguyen, D.D.S.

  • Dentist
  • San Jose, CA
  • NPI 1891714754
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1649406133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1692 TULLY ROAD",
            "address_2": "#4",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95122",
            "telephone_number": "408-223-6953",
            "fax_number": "408-223-0749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2114 SENIOR ROAD",
            "address_2": "SUITE 25",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95112",
            "telephone_number": "408-279-2114",
            "fax_number": "408-279-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1692 TULLY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "PHUNG",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "408-279-2114",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "44749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in San Jose, CA
• Providers in San Jose, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.