Healthcare Provider Details

I. General information

NPI: 1962331116
Provider Name (Legal Business Name): KENNY HOANG TRUONG ABO, NCLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 S LOUISE AVE
SIOUX FALLS SD
57106-0705
US

IV. Provider business mailing address

3209 S LOUISE AVE
SIOUX FALLS SD
57106-0705
US

V. Phone/Fax

Practice location:
  • Phone: 605-362-2620
  • Fax: 605-362-2622
Mailing address:
  • Phone: 605-362-2620
  • Fax: 605-362-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number269755
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: