Provider Demographics
NPI:1548356330
Name:HO, TRUNG D (DDS)
Entity type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:D
Last Name:HO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 GARNET ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3504
Mailing Address - Country:US
Mailing Address - Phone:703-297-1888
Mailing Address - Fax:
Practice Address - Street 1:4826 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6917
Practice Address - Country:US
Practice Address - Phone:310-827-7767
Practice Address - Fax:703-941-8955
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6655122300000X
CA62836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist