Provider Demographics
NPI:1508932393
Name:TRUONG, QUYNH HOA THI (OD)
Entity Type:Individual
Prefix:
First Name:QUYNH HOA
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DEL PADRE
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1839
Mailing Address - Country:US
Mailing Address - Phone:949-454-9786
Mailing Address - Fax:
Practice Address - Street 1:21200 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5411
Practice Address - Country:US
Practice Address - Phone:714-374-2626
Practice Address - Fax:714-374-2628
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9688T152W00000X
TX4565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10744OtherDAVIS VISION PROVIDER NO.
CA12361OtherMEDICAL EYE SERVICES
CA917718OtherEYE MED PROVIDER NUMBER
CA6982626OtherVSP