Provider Demographics
NPI:1376834143
Name:TRUONG, MICHAEL NAM (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NAM
Last Name:TRUONG
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 1:340 S LEMON AVE
Mailing Address - Street 2:# 8030
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2706
Mailing Address - Country:US
Mailing Address - Phone:310-912-2305
Mailing Address - Fax:
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:STE 101B
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-263-0557
Practice Address - Fax:213-986-9953
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA124243208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program