Provider Demographics
NPI:1982037503
Name:TRUONG, THINH
Entity Type:Individual
Prefix:
First Name:THINH
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 DALE ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2251
Mailing Address - Country:US
Mailing Address - Phone:714-527-2396
Mailing Address - Fax:714-527-0212
Practice Address - Street 1:8030 DALE ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2251
Practice Address - Country:US
Practice Address - Phone:714-527-2396
Practice Address - Fax:714-527-0212
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist