Healthcare Provider Details

I. General information

NPI: 1043003437
Provider Name (Legal Business Name): TINA TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 SW WESTERN AVE
BEAVERTON OR
97005-3460
US

IV. Provider business mailing address

17588 SW KEYSTONE CT
ALOHA OR
97007-6411
US

V. Phone/Fax

Practice location:
  • Phone: 800-213-2000
  • Fax:
Mailing address:
  • Phone: 971-407-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8926
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: