Healthcare Provider Details

I. General information

NPI: 1699969378
Provider Name (Legal Business Name): PHU VINH TRUONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 W. CECIL
DELANO CA
93216
US

IV. Provider business mailing address

1412 S KENMORE ST
ANAHEIM CA
92804-5127
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-2345
  • Fax:
Mailing address:
  • Phone: 714-588-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: