Provider Demographics
NPI:1689900995
Name:TRUONG, MICHAEL DUC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DUC
Last Name:TRUONG
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:818-518-3034
Mailing Address - Fax:510-879-9123
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:ATTN: DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:818-518-3034
Practice Address - Fax:909-580-1388
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant