1629741772 NPI number — YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629741772 NPI number — YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YEN HAI DUONG, DDS & JIMMY TRAN, DMD, INC
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:
1629741772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9317 BOLSA AVE UNIT 2099
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92684-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-714-0818
Provider Business Mailing Address Fax Number:
714-775-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4170 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-3322
Provider Business Practice Location Address Fax Number:
619-563-8888
Provider Enumeration Date:
07/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
DUONG
Authorized Official First Name:
TUAN
Authorized Official Middle Name:
QUOC
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
714-553-5288

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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