Provider Demographics
NPI:1912104357
Name:TRUONG, HOANG THI (DDS)
Entity type:Individual
Prefix:DR
First Name:HOANG
Middle Name:THI
Last Name:TRUONG
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 1:2550 W EL CAMINO AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3900
Mailing Address - Country:US
Mailing Address - Phone:916-649-0249
Mailing Address - Fax:916-649-0258
Practice Address - Street 1:2550 W EL CAMINO AVE STE 9
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3900
Practice Address - Country:US
Practice Address - Phone:916-649-0249
Practice Address - Fax:916-649-0258
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
12054842OtherCAQH