Provider Demographics
NPI:1821044173
Name:TRUONG, HAI K (DO)
Entity Type:Individual
Prefix:DR
First Name:HAI
Middle Name:K
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 E 21ST STREET N
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-686-7338
Practice Address - Street 1:7111 E 21ST STREET N
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-686-7338
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-22786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS622291Medicaid
KS101597OtherCHAMPUS
KS110718OtherBCBS GROUP
KS101597OtherBCBS INDIVIDUAL
KS100231200BMedicaid
KS100416440AMedicaid
KS622291Medicaid
KS101597OtherBCBS INDIVIDUAL
KS101597Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
KS80186350Medicare ID - Type UnspecifiedRAILROAD MEDICARE