Provider Demographics
NPI:1497396915
Name:CHEN & TRIEU PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:CHEN & TRIEU PROFESSIONAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:V
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-367-6740
Mailing Address - Street 1:20810 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1319
Mailing Address - Country:US
Mailing Address - Phone:626-367-6740
Mailing Address - Fax:
Practice Address - Street 1:20810 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1319
Practice Address - Country:US
Practice Address - Phone:626-367-6740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54701OtherDENTAL LICENSE
CA1922297183Medicaid