Provider Demographics
NPI:1235164096
Name:NGUYEN, TRUNG T (MD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:T
Last Name:NGUYEN
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:PO BOX 4019
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9552
Mailing Address - Country:US
Mailing Address - Phone:310-372-0123
Mailing Address - Fax:310-544-6855
Practice Address - Street 1:550 DEEP VALLEY DR STE 319
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-7604
Practice Address - Country:US
Practice Address - Phone:310-544-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC159386207Q00000X
TNMD40492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000577Medicaid
TN3000577Medicaid