Provider Demographics
NPI:1528639077
Name:KHA, VICTORIA TRUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:TRUONG
Last Name:KHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3054
Mailing Address - Country:US
Mailing Address - Phone:909-792-9430
Mailing Address - Fax:
Practice Address - Street 1:508 W COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3054
Practice Address - Country:US
Practice Address - Phone:909-792-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106246122300000X, 1223D0001X, 1223G0001X
CADDS1062461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health