Provider Demographics
NPI:1962522185
Name:TRUONG, VY THI TUONG (DDS)
Entity type:Individual
Prefix:MRS
First Name:VY
Middle Name:THI TUONG
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 1:1855 ALUM ROCK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-254-1995
Mailing Address - Fax:408-254-1996
Practice Address - Street 1:1855 ALUM ROCK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-254-1995
Practice Address - Fax:408-254-1996
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4553201Medicaid