Provider Demographics
NPI:1003892548
Name:TRUONG, KHAI C (MD)
Entity Type:Individual
Prefix:MR
First Name:KHAI
Middle Name:C
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-8043
Mailing Address - Country:US
Mailing Address - Phone:270-988-7256
Mailing Address - Fax:270-988-3900
Practice Address - Street 1:1860 JH OBRYAN AVE
Practice Address - Street 2:
Practice Address - City:GRAND RIVERS
Practice Address - State:KY
Practice Address - Zip Code:42045-9049
Practice Address - Country:US
Practice Address - Phone:270-362-8246
Practice Address - Fax:270-362-9757
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64088784Medicaid
KY65944019Medicaid
KY000000623499OtherANTHEM BC&BS
KY7100091610Medicaid
KY000000370768OtherBC/BS
KYI16194Medicare UPIN
KY64088784Medicaid
KYK001840Medicare PIN
KY3403501Medicare PIN