San Jose Dental Surgery Center, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

D52747 Issued in CA

Legal business name

SAN JOSE DENTAL SURGERY CENTER, INC.

Practice address

2048 Story Rd
San Jose, CA 95122-1668

Phone

(408) 240-9000

NPI assigned

Nov 9, 2007

Organization subpart

No

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

Authorized official

Name

Kham Nguyen, DDSNPI 1447262357

Title

Vice President

Phone

(408) 240-9000

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Ambulatory surgical center certification: CCN 05C0001869

Legal name

San Jose Dental Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Feb 10, 2009

Last certification

Apr 10, 2019

Ownership / control type

Proprietary

Facility address

2048 Story Road
San Jose, CA 95122

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kham Vu Nguyen, D.D.S

  • Dentist
  • San Jose, CA
  • NPI 1447262357
  NPD (past) Authorized official
• Suong Thi-Tuyet Le, D.D.S.

  • General Practice Dentistry
  • San Jose, CA
  • NPI 1134276124
  NPD
• Mary Alvarez-Nutting

  • Family Nurse Practitioner
  • San Jose, CA
  • NPI 1447732409
  NPD (past)
• Andrew P Horsley, M.D.

  • Anesthesiology Physician
  • Freedom, CA
  • NPI 1417020942
  NPD (past)

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743811200000",
    "number": "1902086606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2048 STORY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221668",
            "telephone_number": "408-240-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2048 STORY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221668",
            "telephone_number": "408-240-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE DENTAL SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2025-04-05",
        "certification_date": "2025-04-05",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KHAM",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "408-240-9000",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "D52747",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "D52747",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL LICENSE NUMBER",
            "identifier": "D52747",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Jose City College Student Health Services
• San Jose Conservation Corps
• San Jose Counseling Center: a Marriage Family Therapy Corporation (J Woodfin Counseling)
• San Jose Counseling, Inc.
• San Jose Dental Care
• San Jose Dentistry & Implants (S Singh DDS Inc)
• San Jose Doctors on Duty
• San Jose Eye Care Optometry Professional Corporation
• San Jose Eye Institute Medical Corporation
• San Jose Family Health Center

• Ambulatory Surgical Clinic/Center in San Jose, CA
• Providers in San Jose, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.