MEDICARE: DR. TRUC TRUNG MAI D.M.D

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	44934	CA

General Provider Information

NPI Number	:	1417928797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRUC TRUNG MAI D.M.D

Provider Business Mailing Address
First Line	:	1161 HIDDEN VALLEY PKWY
Second Line	:	SUITE 106
City	:	NORCO
State	:	CA
Zip	:	92860
Country	:	US
Telephone Number	:	957-479-9410
Fax Number	:	951-817-0649

Provider Business Practice Location Address
First Line	:	1161 HIDDEN VALLEY PKWY
Second Line	:	SUITE 106
City	:	NORCO
State	:	CA
Zip	:	92860
Country	:	US
Telephone Number	:	957-479-9410
Fax Number	:	951-817-0649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/08/2007

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