MEDICARE: MS. BAO-TRAN LUU TRUONG DMD

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	1223G0001X	General Practice Dentistry	101838	CA

General Provider Information

NPI Number	:	1619493327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BAO-TRAN LUU TRUONG DMD

Provider Business Mailing Address
First Line	:	2202 S LOWELL ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3113
Country	:	US
Telephone Number	:	949-610-3707
Fax Number	:

Provider Business Practice Location Address
First Line	:	4531 PHILADELPHIA ST STE B107
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2249
Country	:	US
Telephone Number	:	909-902-9100
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	07/21/2022

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