Provider Demographics
NPI:1659380814
Name:TRUONG, SON V (MD)
Entity Type:Individual
Prefix:
First Name:SON
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 1:3009 N. CYPRESS
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4003
Mailing Address - Country:US
Mailing Address - Phone:316-440-1010
Mailing Address - Fax:316-440-0802
Practice Address - Street 1:3009 N. CYPRESS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4003
Practice Address - Country:US
Practice Address - Phone:316-440-1010
Practice Address - Fax:316-440-0802
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428400207RC0200X, 207RS0012X, 207RP1001X
KS04-28400207RC0200X, 207RP1001X, 207RS0012X
KS28400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12149414OtherMULTIPLAN
KS200257440EMedicaid
KS9212OtherPHS
KS201077OtherHPK
KS216659OtherCOVENTRY
KS103697OtherBCBS
KS200257440AMedicaid
KS200257440DMedicaid
OK200065620AMedicaid
KS12149414OtherMULTIPLAN
KS103697OtherBCBS
I03428Medicare UPIN
KS200257440DMedicaid
KA2253006Medicare PIN