Provider Demographics
NPI:1023096765
Name:TRUONG, MICHAEL PM (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PM
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8038
Mailing Address - Country:US
Mailing Address - Phone:949-364-3330
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-3330
Practice Address - Fax:949-364-3682
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58851207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G588510Medicaid
CAA53450Medicare UPIN
CA00G588510Medicaid
CAWG58851BMedicare PIN