Provider Demographics
NPI:1700964251
Name:TO, TRANG HUYEN (DMD)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:HUYEN
Last Name:TO
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 1:18 SWEET FLDS
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4172
Mailing Address - Country:US
Mailing Address - Phone:714-855-7007
Mailing Address - Fax:
Practice Address - Street 1:17240 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6105
Practice Address - Country:US
Practice Address - Phone:813-288-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700964251Medicaid
CA1700964251Medicare PIN
CA1700964251Medicare Oscar/Certification
CA1700964251Medicare UPIN
CA1700964251Medicaid