MEDICARE: JESSICA T TRUONG DDS & DANNY T TRUONG DDS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	39993	CA

General Provider Information

NPI Number	:	1124561659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA T TRUONG DDS & DANNY T TRUONG DDS, INC

Provider Business Mailing Address
First Line	:	9878 HIBERT ST STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1020
Country	:	US
Telephone Number	:	858-779-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	9878 HIBERT ST STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1020
Country	:	US
Telephone Number	:	858-779-3111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESSICA TRUONG
Credential	:	DDS
Telephone Number	:	619-972-1046

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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