Provider Demographics
NPI:1477969400
Name:TRUONG, THANHNGA THI
Entity Type:Individual
Prefix:
First Name:THANHNGA
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15355 BROOKHURST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7071
Mailing Address - Country:US
Mailing Address - Phone:718-930-9981
Mailing Address - Fax:
Practice Address - Street 1:15355 BROOKHURST ST STE 101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7071
Practice Address - Country:US
Practice Address - Phone:714-486-2958
Practice Address - Fax:714-486-2639
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302831223G0001X
CA639891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice