Provider Demographics
NPI:1114236635
Name:THOA TRONG DO MD PROF. CORP.
Entity Type:Organization
Organization Name:THOA TRONG DO MD PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOA
Authorized Official - Middle Name:TRONG
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-839-0294
Mailing Address - Street 1:14350 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4608
Mailing Address - Country:US
Mailing Address - Phone:714-839-0294
Mailing Address - Fax:714-839-1082
Practice Address - Street 1:14350 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4608
Practice Address - Country:US
Practice Address - Phone:714-839-0294
Practice Address - Fax:714-839-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43520261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435200Medicaid
CAA43520Medicare PIN
CA00A435200Medicaid