Provider Demographics
NPI:1003405093
Name:TRUONG, BIEN
Entity type:Individual
Prefix:
First Name:BIEN
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIEN
Other - Middle Name:
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DR BIEN TRUONG
Mailing Address - Street 1:1967 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01128-1225
Mailing Address - Country:US
Mailing Address - Phone:413-883-2926
Mailing Address - Fax:
Practice Address - Street 1:1967 PARKER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1225
Practice Address - Country:US
Practice Address - Phone:413-883-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS68895808OtherDIVER LICENSE