1649308990 NPI number — QUYNH HOA TRUONG, O.D., A PROFESSIONAL CORPORATION

Table of content: (NPI 1649308990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649308990 NPI number — QUYNH HOA TRUONG, O.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUYNH HOA TRUONG, O.D., 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:
1649308990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 DEL PADRE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOOTHILL RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92610-1839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-454-9786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19051 GOLDENWEST ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-698-2626
Provider Business Practice Location Address Fax Number:
714-698-2628
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRUONG
Authorized Official First Name:
QUYNH HOA
Authorized Official Middle Name:
THI
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
714-698-2626

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  9688T , 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: 10744 . This is a "DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: TRUONG . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 917718 . This is a "EYE MED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 12361 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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