Provider Demographics
NPI:1306982483
Name:DOAN, TRUNG KIEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:KIEN
Last Name:DOAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 W CHAPMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2743
Mailing Address - Country:US
Mailing Address - Phone:714-634-8111
Mailing Address - Fax:714-634-1611
Practice Address - Street 1:1409 W CHAPMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2743
Practice Address - Country:US
Practice Address - Phone:714-634-8111
Practice Address - Fax:714-634-1611
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47365Medicaid