Provider Demographics
NPI:1629741772
Name:YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC
Entity Type:Organization
Organization Name:YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:714-553-5288
Mailing Address - Street 1:9317 BOLSA AVE UNIT 2099
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92684-2321
Mailing Address - Country:US
Mailing Address - Phone:714-714-0818
Mailing Address - Fax:714-775-3595
Practice Address - Street 1:4170 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1610
Practice Address - Country:US
Practice Address - Phone:619-280-3322
Practice Address - Fax:619-563-8888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental