Provider Demographics
NPI:1568076495
Name:TRUONG, SHAWNY
Entity Type:Individual
Prefix:
First Name:SHAWNY
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 LA SENA AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-1837
Mailing Address - Country:US
Mailing Address - Phone:626-488-4555
Mailing Address - Fax:
Practice Address - Street 1:3131 SANTA ANITA AVE STE 112B
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1369
Practice Address - Country:US
Practice Address - Phone:626-636-2370
Practice Address - Fax:626-453-3415
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14024-RAC101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)