Provider Demographics
NPI:1225009616
Name:TRUONG, THANH N (DO)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:N
Last Name:TRUONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 E 21ST STREET N
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-686-7338
Practice Address - Street 1:7111 E 21ST STREET N
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-686-7338
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-21960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100230970DMedicaid
KS100416440AMedicaid
KS103153OtherBLUE CROSS
KS607840Medicaid
KSRAILROAD MEDICAREOtherP00057329
KS100416440AMedicaid
KS103153Medicare ID - Type UnspecifiedINDIVIDUAL
KS110718Medicare ID - Type UnspecifiedGROUP