Provider Demographics
NPI:1083718365
Name:DAVID M. TRUONG, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID M. TRUONG, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-274-9969
Mailing Address - Street 1:10900 WARNER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3846
Mailing Address - Country:US
Mailing Address - Phone:714-274-9969
Mailing Address - Fax:714-274-9973
Practice Address - Street 1:10900 WARNER AVE STE 201
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-274-9969
Practice Address - Fax:714-274-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74460207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G744601Medicaid
CAG74460OtherSTATE MEDICAL LICENSE
CABS054AMedicare PIN
F92275Medicare UPIN