Provider Demographics
NPI:1104283878
Name:QUANG, TRINA
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:QUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14333 TYLER ST
Mailing Address - Street 2:40
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-362-2708
Mailing Address - Fax:
Practice Address - Street 1:14333 TYLER ST
Practice Address - Street 2:40
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1400
Practice Address - Country:US
Practice Address - Phone:626-319-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29425124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist