MEDICARE: RICHARD TRI QUAN TRUONG D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	62720	CA

General Provider Information

NPI Number	:	1720413735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD TRI QUAN TRUONG D.M.D

Provider Business Mailing Address
First Line	:	598 WARWICK AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-1944
Country	:	US
Telephone Number	:	510-388-0616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 PARKSIDE DR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2525
Country	:	US
Telephone Number	:	925-689-0811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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