Provider Demographics
NPI:1508824368
Name:TRUONG, NHU VAN (MD)
Entity Type:Individual
Prefix:
First Name:NHU
Middle Name:VAN
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 1:10402 WESTMINSTER AVE
Mailing Address - Street 2:#100B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4844
Mailing Address - Country:US
Mailing Address - Phone:714-539-4946
Mailing Address - Fax:714-539-4810
Practice Address - Street 1:10402 WESTMINSTER AVE
Practice Address - Street 2:#100B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4844
Practice Address - Country:US
Practice Address - Phone:714-539-4946
Practice Address - Fax:714-539-4810
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A522531Medicaid
G00073Medicare UPIN
CAA52253Medicare ID - Type Unspecified