Provider Demographics
NPI:1861689705
Name:TRUONG, MAI THY T (MD)
Entity Type:Individual
Prefix:DR
First Name:MAI THY
Middle Name:T
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3722
Mailing Address - Country:US
Mailing Address - Phone:650-922-3955
Mailing Address - Fax:650-725-5962
Practice Address - Street 1:801 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1611
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-725-5962
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88089207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology