Healthcare Provider Details

I. General information

NPI: 1649308990
Provider Name (Legal Business Name): QUYNH HOA TRUONG, O.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19051 GOLDENWEST ST SUITE 102
HUNTINGTON BEACH CA
92648-2155
US

IV. Provider business mailing address

22 DEL PADRE
FOOTHILL RANCH CA
92610-1839
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-2626
  • Fax: 714-698-2628
Mailing address:
  • Phone: 949-454-9786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9688T
License Number StateCA

VIII. Authorized Official

Name: QUYNH HOA THI TRUONG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: O.D.
Phone: 714-698-2626