Healthcare Provider Details

I. General information

NPI: 1912104357
Provider Name (Legal Business Name): HOANG THI TRUONG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W EL CAMINO AVE STE 9
SACRAMENTO CA
95833-3900
US

IV. Provider business mailing address

2550 W EL CAMINO AVE STE 9
SACRAMENTO CA
95833-3900
US

V. Phone/Fax

Practice location:
  • Phone: 916-649-0249
  • Fax: 916-649-0258
Mailing address:
  • Phone: 916-649-0249
  • Fax: 916-649-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number54687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: