Provider Demographics
NPI:1407897473
Name:TRUONG, PHUC HUY (MD)
Entity Type:Individual
Prefix:
First Name:PHUC
Middle Name:HUY
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:PHUC HUY
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-966-2045
Mailing Address - Fax:714-966-9392
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:STE 207
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-966-2045
Practice Address - Fax:714-966-9392
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36401208000000X, 208D00000X
MN25537208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A364010Medicaid