Provider Demographics
NPI:1588700678
Name:TRUNG K. DOAN, DDS, INC.
Entity type:Organization
Organization Name:TRUNG K. DOAN, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:KIEN
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-634-8111
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92849-01Medicaid