Healthcare Provider Details

I. General information

NPI: 1285653758
Provider Name (Legal Business Name): TRUC THANH NGUYEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32700 ALVARADO BLVD 15931 HESPERIAN BLVD SAN LORENZO, CA 94580
FREMONT CA
94555-1202
US

IV. Provider business mailing address

32700 ALVARADO BLVD 15931 HESPERIAN BLVD SAN LORENZO, CA 94580
FREMONT CA
94555-1202
US

V. Phone/Fax

Practice location:
  • Phone: 510-477-0811
  • Fax:
Mailing address:
  • Phone: 510-477-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: