Provider Demographics
NPI:1801877170
Name:TRUONG, TRUNG (MD)
Entity type:Individual
Prefix:
First Name:TRUNG
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30492 GATEWAY PL STE 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1899
Mailing Address - Country:US
Mailing Address - Phone:949-542-7700
Mailing Address - Fax:949-361-8163
Practice Address - Street 1:30492 GATEWAY PL STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1899
Practice Address - Country:US
Practice Address - Phone:949-542-7700
Practice Address - Fax:949-361-8163
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G796040Medicaid
CAFB037ZMedicare PIN
CAG31653Medicare UPIN
CAAP689ZMedicare PIN
CAAP689ZMedicare PIN