Provider Demographics
NPI:1639499189
Name:TRUONG, TRUNG VU
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:VU
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 1:1020 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4757
Mailing Address - Country:US
Mailing Address - Phone:626-570-8018
Mailing Address - Fax:626-570-8018
Practice Address - Street 1:1528 E AMAR RD
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1618
Practice Address - Country:US
Practice Address - Phone:626-965-2016
Practice Address - Fax:626-965-5386
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist