1376546176 NPI number — SARA T. TRUONG, D.D.S., A PROFESSIONAL CORPORATION

Table of content: (NPI 1376546176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376546176 NPI number — SARA T. TRUONG, D.D.S., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARA T. TRUONG, D.D.S., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376546176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
485 SOUTH DR
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94040-4208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-961-4766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
485 SOUTH DR
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94040-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-961-4766
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TRUONG
Authorized Official First Name:
SARA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
650-961-4766

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  46705 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001313570 . This is a "UNITED CONCORDIA PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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