Provider Demographics
NPI:1619493327
Name:TRUONG, BAO-TRAN LUU (DMD)
Entity Type:Individual
Prefix:MS
First Name:BAO-TRAN
Middle Name:LUU
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 S LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3113
Mailing Address - Country:US
Mailing Address - Phone:949-610-3707
Mailing Address - Fax:
Practice Address - Street 1:4531 PHILADELPHIA ST STE B107
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2249
Practice Address - Country:US
Practice Address - Phone:909-902-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1018381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice