Provider Demographics
NPI:1124002688
Name:TRUONG, JELIN YEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JELIN
Middle Name:YEN
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:9235 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PLANADA
Practice Address - State:CA
Practice Address - Zip Code:95365-8088
Practice Address - Country:US
Practice Address - Phone:209-382-0253
Practice Address - Fax:209-382-2110
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A846920OtherBLUE SHIELD OF CA PIN
CA00A846920OtherBLUE SHIELD OF CA PIN
CA00A846920Medicare ID - Type Unspecified
CA00A846920OtherBLUE SHIELD OF CA PIN