Provider Demographics
NPI:1235432592
Name:TRUONG, CHUNG NGOC (DDS)
Entity Type:Individual
Prefix:
First Name:CHUNG
Middle Name:NGOC
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 1:2016 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-2821
Mailing Address - Country:US
Mailing Address - Phone:831-722-2816
Mailing Address - Fax:
Practice Address - Street 1:2016 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-2821
Practice Address - Country:US
Practice Address - Phone:831-722-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice