Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA73684 | CA |
NPI | 1225650583 |
---|---|
Provider Name | Miss Dao Tien Truong |
First Address | Rosemead, CA 91770-2430 |
Second Address | East Los Angeles, CA 90022-3932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2020 |
Last Update Date | 09/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA73684 | (05) | CA |