Provider Demographics
NPI:1235251844
Name:TRUONG, CHAU T (DDS)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:T
Last Name:TRUONG
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 1:713 BROADWAY
Mailing Address - Street 2:STE F
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-425-8785
Mailing Address - Fax:619-425-8179
Practice Address - Street 1:713 BROADWAY
Practice Address - Street 2:STE F
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-425-8785
Practice Address - Fax:619-425-8179
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B4411101Medicare ID - Type UnspecifiedDENTICAL