Provider Demographics
NPI:1447211495
Name:ANDY N TRUONG M.D, INC.
Entity Type:Organization
Organization Name:ANDY N TRUONG M.D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-323-6446
Mailing Address - Street 1:16027 BROOKHURST ST
Mailing Address - Street 2:G-135
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1551
Mailing Address - Country:US
Mailing Address - Phone:714-323-6446
Mailing Address - Fax:714-844-9494
Practice Address - Street 1:16027 BROOKHURST ST
Practice Address - Street 2:G-135
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1551
Practice Address - Country:US
Practice Address - Phone:714-323-6446
Practice Address - Fax:714-844-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09476ZOtherBLUE SHIELD OF CALIFORNIA
CAW16589Medicare ID - Type UnspecifiedMEDICARE GROUP I.D