Provider Demographics
NPI:1356088983
Name:YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC.
Entity Type:Organization
Organization Name:YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-553-5288
Mailing Address - Street 1:18102 IRVINE BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3424
Mailing Address - Country:US
Mailing Address - Phone:714-714-0818
Mailing Address - Fax:
Practice Address - Street 1:525 N AZUSA AVE STE 112
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4261
Practice Address - Country:US
Practice Address - Phone:626-336-4453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental