Provider Demographics
NPI:1477611762
Name:TRUONG, KEVIN THUC (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THUC
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 1:2560 S BARRINGTON AVE
Mailing Address - Street 2:201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2879
Mailing Address - Country:US
Mailing Address - Phone:310-268-8417
Mailing Address - Fax:
Practice Address - Street 1:2320 S ROBERTSON BLVD
Practice Address - Street 2:102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2060
Practice Address - Country:US
Practice Address - Phone:310-839-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice