Provider Demographics
NPI:1811004740
Name:TRUONG, HOAN-VU (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOAN-VU
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15290 SUMMIT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1009
Mailing Address - Country:US
Mailing Address - Phone:909-899-8811
Mailing Address - Fax:909-899-8891
Practice Address - Street 1:15290 SUMMIT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1009
Practice Address - Country:US
Practice Address - Phone:909-899-8811
Practice Address - Fax:909-899-8891
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice