Provider Demographics
NPI:1740649672
Name:LOAN T. TRUONG, M.D., INC.
Entity type:Organization
Organization Name:LOAN T. TRUONG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-253-6208
Mailing Address - Street 1:855 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3550
Mailing Address - Country:US
Mailing Address - Phone:562-591-0840
Mailing Address - Fax:562-591-4191
Practice Address - Street 1:855 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3550
Practice Address - Country:US
Practice Address - Phone:562-591-0840
Practice Address - Fax:562-591-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-20
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty