Provider Demographics
NPI: | 1508068354 |
---|---|
Name: | TRI TRUONG, MD |
Entity Type: | Organization |
Organization Name: | TRI TRUONG, MD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TRI |
Authorized Official - Middle Name: | MINH |
Authorized Official - Last Name: | TRUONG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 702-399-9161 |
Mailing Address - Street 1: | 341 N BUFFALO DR |
Mailing Address - Street 2: | SUITE B |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89145-0376 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-228-5691 |
Mailing Address - Fax: | 702-228-5653 |
Practice Address - Street 1: | 2354 E BONANZA RD |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89101-3451 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-399-9161 |
Practice Address - Fax: | 702-399-9125 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-06-04 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 07936126135097 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |