Provider Demographics
NPI:1497786164
Name:TRUONG, NGOCCAM THI (MD)
Entity Type:Individual
Prefix:DR
First Name:NGOCCAM
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4718
Mailing Address - Country:US
Mailing Address - Phone:503-284-7746
Mailing Address - Fax:503-287-7364
Practice Address - Street 1:6236 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4718
Practice Address - Country:US
Practice Address - Phone:503-284-7746
Practice Address - Fax:503-287-7364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13856208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR21023-7Medicaid
ORC94534Medicare UPIN
OR21023-7Medicaid