Provider Demographics
NPI:1639204084
Name:TRUONG, MYDUNG THI (OD)
Entity Type:Individual
Prefix:DR
First Name:MYDUNG
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15521 SANDUSKY LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7231
Mailing Address - Country:US
Mailing Address - Phone:714-893-2816
Mailing Address - Fax:
Practice Address - Street 1:13331 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-9207
Practice Address - Country:US
Practice Address - Phone:714-799-2784
Practice Address - Fax:714-799-0144
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10559T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist