Provider Demographics
NPI:1518922814
Name:TRUONG, QUOC V (MD)
Entity Type:Individual
Prefix:
First Name:QUOC
Middle Name:V
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 1:818 N ENMPORIA
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3728
Mailing Address - Country:US
Mailing Address - Phone:316-262-4467
Mailing Address - Fax:316-262-0706
Practice Address - Street 1:818 N ENMPORIA
Practice Address - Street 2:SUITE 403
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3728
Practice Address - Country:US
Practice Address - Phone:316-262-4467
Practice Address - Fax:316-262-0706
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29779207R00000X
KS0429779207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100424320BMedicaid
KS104871OtherBLUE CROSS BLUE SHIELD
KS443760OtherFIRSTGUARD
KS443760OtherFIRSTGUARD
KSH68962Medicare UPIN