Provider Demographics
NPI:1275667271
Name:LY, TRUC TRUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:TRUC
Middle Name:TRUNG
Last Name:LY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:210-798-4311
Mailing Address - Fax:210-798-4318
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-798-4311
Practice Address - Fax:210-798-4318
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2017-04-12
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Provider Licenses
StateLicense IDTaxonomies
TXR1238208600000X, 208G00000X
IL036-124096208G00000X
IN01071407A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX558179YKRCMedicare PIN
IN200968040Medicaid
ININ1041007Medicare PIN