Provider Demographics
NPI:1730457292
Name:TRUONG, SYDNEE KIM (NP)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEE
Middle Name:KIM
Last Name:TRUONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8526 DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8676
Practice Address - Country:US
Practice Address - Phone:702-724-8777
Practice Address - Fax:702-724-8749
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20017363LF0000X
NVAPRN002177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDINGMedicare PIN
NV1730457292Medicaid