Healthcare Provider Details

I. General information

NPI: 1073733697
Provider Name (Legal Business Name): QUYNH TRAM T TRUONG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 E 17TH ST SUITE B
SANTA ANA CA
92705-8535
US

IV. Provider business mailing address

1641 E 17TH ST SUITE B
SANTA ANA CA
92705-8535
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-7400
  • Fax: 714-543-3536
Mailing address:
  • Phone: 714-542-7400
  • Fax: 714-543-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47426
License Number StateCA

VIII. Authorized Official

Name: DR. QUYNH-TRAM THI TRUONG
Title or Position: CEO
Credential: D.D.S.
Phone: 714-542-7400