Provider Demographics
NPI:1649308990
Name:QUYNH HOA TRUONG, O.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:QUYNH HOA TRUONG, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:QUYNH HOA
Authorized Official - Middle Name:THI
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-698-2626
Mailing Address - Street 1:22 DEL PADRE
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1839
Mailing Address - Country:US
Mailing Address - Phone:949-454-9786
Mailing Address - Fax:
Practice Address - Street 1:19051 GOLDENWEST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2155
Practice Address - Country:US
Practice Address - Phone:714-698-2626
Practice Address - Fax:714-698-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9688T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10744OtherDAVIS VISION
CATRUONGOtherVISION SERVICE PLAN
CA917718OtherEYE MED
CA12361OtherMEDICAL EYE SERVICES