Provider Demographics
NPI:1356728299
Name:TRUONG, ALLISON KIM (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:KIM
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PLAZA #450
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:310-825-6911
Mailing Address - Fax:
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2285
Practice Address - Country:US
Practice Address - Phone:310-385-3300
Practice Address - Fax:310-385-3366
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA146828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD9643255OtherDRIVER'S LICENSE