Provider Demographics
NPI:1952821829
Name:TRUONG, MY-LIEN THI (MD)
Entity Type:Individual
Prefix:
First Name:MY-LIEN
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MY-LIEN
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3175 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6729
Mailing Address - Country:US
Mailing Address - Phone:941-627-6465
Mailing Address - Fax:
Practice Address - Street 1:3175 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6729
Practice Address - Country:US
Practice Address - Phone:941-627-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016683208000000X
OK390200000X2085R0001X
IAMD-479632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics