Provider Demographics
NPI:1891892675
Name:TRUONG, KEVIN ANH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANH
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANH
Other - Middle Name:THACH
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13871 BREEDERS CUP DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5142
Mailing Address - Country:US
Mailing Address - Phone:281-419-0963
Mailing Address - Fax:
Practice Address - Street 1:9250 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3218
Practice Address - Country:US
Practice Address - Phone:281-364-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025014207P00000X
TXL6685207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159190106Medicaid
TX8AK945OtherBCBS
TX159190105Medicaid
TX8K3645Medicare PIN
TXH78620Medicare UPIN
TX8K3646Medicare PIN
TX159190106Medicaid
TXP00667181Medicare Oscar/Certification